Provider Demographics
NPI:1407928005
Name:JENNE, LOUISE GREER (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:GREER
Last Name:JENNE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 CRAIN HWY
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2830
Mailing Address - Country:US
Mailing Address - Phone:301-645-3556
Mailing Address - Fax:301-645-3932
Practice Address - Street 1:3070 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2830
Practice Address - Country:US
Practice Address - Phone:301-645-3556
Practice Address - Fax:301-645-3932
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR035956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
008593M92Medicare ID - Type Unspecified
P45748Medicare UPIN