Provider Demographics
NPI:1366878886
Name:MCGEORGE, JENNIFER H (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:MCGEORGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:50923 HIGHWAY 6 AND 24
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-2537
Practice Address - Country:US
Practice Address - Phone:970-945-8631
Practice Address - Fax:970-928-8779
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148884367A00000X
COC-APN.0003358-C-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000200723Medicaid