Provider Demographics
NPI:1588786644
Name:YOW, JENNIFER MARTIN
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARTIN
Last Name:YOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RENFORTH RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4692
Mailing Address - Country:US
Mailing Address - Phone:704-965-0396
Mailing Address - Fax:
Practice Address - Street 1:ONE ST. FRANCIS DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3955
Practice Address - Country:US
Practice Address - Phone:864-255-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC159742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered