Jennissen, Charles Anthony

Jennissen, Charles Anthony is an individual health care provider with primary practice located at 200 Hawkins Dr , Iowa City IA 52242-1009. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine, which is considered as his primary health care specialty. Jennissen, Charles Anthony can be contacted via phone (319) 356-6360.

Contact Information

Primary practice address
200 Hawkins Dr Iowa City IA 52242-1009
Phone: (319) 356-6360
Fax: (319) 384-9184
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X 26724 Iowa

Profile Details

NPI number 1033194188
LBN Legal business name Jennissen, Charles Anthony
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Dec 11th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033194188 NPPES
Iowa Other 34154 WELLMARK BCBS
Iowa MEDICAID 1101659 WELLMARK BCBS

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