Individual
JENNIFER THERESE MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-4180
(920) 288-4182
Mailing address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-4180
(920) 288-4182
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3665-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679942122
—
WI
Enumeration date
09/15/2015
Last updated
11/24/2021
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