Provider Demographics
NPI:1457980104
Name:GREULICH, JENNIFER ROSE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:GREULICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:BROMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 DORBETT STREET
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2615
Mailing Address - Country:US
Mailing Address - Phone:812-481-2229
Mailing Address - Fax:812-482-3993
Practice Address - Street 1:613 DORBETT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2615
Practice Address - Country:US
Practice Address - Phone:812-481-2229
Practice Address - Fax:812-482-3993
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092649A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300092354Medicaid