Provider Demographics
NPI:1992735534
Name:RHODE, JENNIFER MORRIS (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MORRIS
Last Name:RHODE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:704 S WEBSTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3528
Practice Address - Country:US
Practice Address - Phone:920-338-6868
Practice Address - Fax:920-338-6869
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10625207VX0201X
OH088696207VX0201X
WI71440-20207VX0201X
UT7181217-1205207VX0201X
WI18295-875207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100081197Medicaid
WY1992735534Medicaid
ID808328300Medicaid
OH2715502Medicaid
UT1053593921Medicaid
572494OtherBOARD CERTIFICATION OB/GYNECOLOGIC ONCOLOGY
P00699201Medicare PIN
4200921Medicare PIN
I67863Medicare UPIN
P00699200Medicare PIN