Provider Demographics
NPI:1205010006
Name:GRENNAN, JILL JENE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JENE
Last Name:GRENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4353 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2709
Mailing Address - Country:US
Mailing Address - Phone:402-552-2020
Mailing Address - Fax:402-552-2367
Practice Address - Street 1:4353 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2709
Practice Address - Country:US
Practice Address - Phone:402-552-2020
Practice Address - Fax:402-552-2367
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35214207W00000X
NE22492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology