Provider Demographics
NPI:1740303056
Name:MCGREW, JENNIFER DENISE (CNIM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:MCGREW
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DENISE
Other - Last Name:CLEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:848 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1738
Mailing Address - Country:US
Mailing Address - Phone:281-250-7055
Mailing Address - Fax:832-519-9548
Practice Address - Street 1:804 HEAVENS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2890
Practice Address - Country:US
Practice Address - Phone:985-845-4538
Practice Address - Fax:866-845-8810
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX992246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX992OtherCERTIFICATION