Basic Information
| Provider Information | |||||||||
| NPI: | 1992716617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULDIN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | OLIN HEALTH CENTER | ||||||||
| Address2: | EAST CIRCLE DRIVE | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488241037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178846546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4200 WHITEHALL DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349950308 | ||||||||
| FaxNumber: | 7349950425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 2083P0901X | 4301051980 | MI | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 2083X0100X | 4301051980 | MI | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4720322 | 05 | MI | MEDICAID |