Basic Information
| Provider Information | |||||||||
| NPI: | 1437214921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBNICKI | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNNE-FELDKAMP | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14650 E OLD US HIGHWAY 12 | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CHELSEA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481181801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345935990 | ||||||||
| FaxNumber: | 7345935995 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR | ||||||||
| Address2: | LOBBY J2000 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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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 | 4704235055 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | 363L00000X | 4704235055 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.