Mahoney, Jennifer Therese

Mahoney, Jennifer Therese is an individual health care provider with primary practice located at 2845 Greenbrier Rd , Green Bay WI 54311-6519. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Mahoney, Jennifer Therese can be contacted via phone (920) 288-4180.

Contact Information

Primary practice address
2845 Greenbrier Rd Green Bay WI 54311-6519
Phone: (920) 288-4180
Fax: (920) 288-4182
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3665-23 Wisconsin

Profile Details

NPI number 1679942122
LBN Legal business name Mahoney, Jennifer Therese
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2015
Last updated Nov 24th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679942122 NPPES
Wisconsin MEDICAID 1679942122

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