Provider Demographics
NPI:1497914758
Name:GREENFIELD, JACQUELINE KAY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KAY
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 INDIAN HILLS DR BLDG 15
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1468
Mailing Address - Country:US
Mailing Address - Phone:641-683-5335
Mailing Address - Fax:641-683-5742
Practice Address - Street 1:603 INDIAN HILLS DR BLDG 15
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1468
Practice Address - Country:US
Practice Address - Phone:641-683-5335
Practice Address - Fax:641-683-5742
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-072256363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health