Provider Demographics
NPI:1750571394
Name:GOJMERAC-OWENS, JENNY (NP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:GOJMERAC-OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:RM AG 001
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-3886
Practice Address - Fax:317-962-8652
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000203A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200880130Medicaid
INP01180504Medicare PIN
INM400023830Medicare PIN
IN264430091Medicare PIN
INM400023827Medicare PIN
IN264430PPPPMedicare PIN
INM400023828Medicare PIN
IN200880130Medicaid
INM400023829Medicare PIN