Active NPI
Jean M McHenry, NP
- Nurse Practitioner
- Green Bay, WI
National Provider Identifier
1679558878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1766
- Practice address
- 3263 Eaton Road
Green Bay, WI 54311 - Phone
- (920) 433-3456
- NPI assigned
- Dec 9, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1766 | WI | Primary |
Addresses
Primary practice location
3263 Eaton Road
Green Bay, WI 54311
Mailing address
3263 Eaton Road
Green Bay, WI 54311
Phone (920) 433-3456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1766-033 | Other | WI | LICENSE |
Other names 1
- Jean M O'Connell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394755200000",
"number": "1679558878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3263 EATON ROAD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "54311",
"telephone_number": "920-433-3456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3263 EATON ROAD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "54311",
"telephone_number": "920-433-3456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCHENRY",
"first_name": "JEAN",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-09",
"last_updated": "2014-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "1766",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "1766-033",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JEAN",
"last_name": "O'CONNELL",
"middle_name": "M",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.