Individual
CHARLES ANTHONY JENNISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-6360
(319) 384-9184
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-6360
(319) 384-9184
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
26724
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101659
—
IA
01
—
34154
WELLMARK BCBS
IA
Enumeration date
12/13/2005
Last updated
12/11/2007
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