Provider Demographics
NPI:1447469952
Name:GREINER, JENNIFER LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:GREINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHERIDAN SQ
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7390
Mailing Address - Country:US
Mailing Address - Phone:423-146-8155
Mailing Address - Fax:423-246-8658
Practice Address - Street 1:5 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7390
Practice Address - Country:US
Practice Address - Phone:423-146-8155
Practice Address - Fax:423-246-8658
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58-002215207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526013Medicaid
103I043316Medicare PIN