Provider Demographics
NPI:1508094764
Name:GREEN, JENNIFER MCGINNIS (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MCGINNIS
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 WOODLAND AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3203
Mailing Address - Country:US
Mailing Address - Phone:515-241-5995
Mailing Address - Fax:515-241-6576
Practice Address - Street 1:1415 WOODLAND AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3203
Practice Address - Country:US
Practice Address - Phone:515-241-5995
Practice Address - Fax:515-241-6576
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine