Provider Demographics
NPI:1932309283
Name:WISHNEW, JENNA L (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:WISHNEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6898 LEBANON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7473
Mailing Address - Country:US
Mailing Address - Phone:972-335-7874
Mailing Address - Fax:214-872-3455
Practice Address - Street 1:6898 LEBANON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7473
Practice Address - Country:US
Practice Address - Phone:972-335-7874
Practice Address - Fax:214-872-3455
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285930801Medicaid
TXTXB135797Medicare PIN