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General NPI Number Information
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NPI Number | 1215744917
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Entity Type | Individual
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Provider Name | JENNA LEE MCGOWAN PA
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1401 W AGENCY RD STE 101
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1647
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Country | US
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Telephone | 319-768-4970
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Fax |
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Provider Business Mailing Address
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Address Line | 116 N 4TH ST STE 302
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City | BURLINGTON
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State | IA
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Zip | 52601-5514
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Country | US
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Telephone | 727-457-0586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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