Basic Information
| Provider Information | |||||||||
| NPI: | 1790857365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEJEUNE | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3409 LUDINGTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498294212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067865707 | ||||||||
| FaxNumber: | 9067894406 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 LUDINGTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498294212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067865707 | ||||||||
| FaxNumber: | 9067894406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 10/10/2016 | ||||||||
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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 | 363L00000X | 4704215161 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 4704215161 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | 4704215161 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.