MEDICARE: JEN GRIGEREK RN CCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	88556	CT

General Provider Information

NPI Number	:	1114703998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEN GRIGEREK RN CCM

Provider Business Mailing Address
First Line	:	440 E SWEDESFORD RD STE 2045
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 E SWEDESFORD RD STE 2045
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-1842
Country	:	US
Telephone Number	:	860-214-6820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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