Provider Demographics
NPI:1548432669
Name:GRABOW, JENNIFER A (WHNP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:A
Last Name:GRABOW
Suffix:
Gender:F
Credentials:WHNP
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Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 4005B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-5016
Mailing Address - Fax:314-567-1846
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 4005B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-5016
Practice Address - Fax:314-567-1846
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001017745363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1548432669Medicaid
MO1548432669Medicaid