Basic Information
| Provider Information | |||||||||
| NPI: | 1336383660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVID | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 EAST STATE RD | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893454967 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5170 RIFLE RIVER TRL | ||||||||
| Address2: | |||||||||
| City: | ALGER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486109343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898735323 | ||||||||
| FaxNumber: | 9898733673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 12/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | 4704224697 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | 363LF0000X | 4704224697 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.