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NPI Code Detail

MEDICARE: JENNIFER ANN LENIUS PA-C

MEDICARE: JENNIFER ANN LENIUS PA-C
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
1363AS0400XSurgical Physician Assistant2006WI
2363A00000XPhysician Assistant2006WI

General Provider Information

NPI Number : 1316049943
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN LENIUS PA-C
Provider Business Mailing Address
First Line : 2430 E MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-3759
Country : US
Telephone Number : 920-406-9863
Fax Number :
Provider Business Practice Location Address
First Line : 2430 E MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-3759
Country : US
Telephone Number : 920-406-9863
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2006
Last Update Date : 01/26/2012

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