Provider Demographics
NPI:1164976122
Name:MAURY, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MAURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26544 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-8504
Mailing Address - Country:US
Mailing Address - Phone:269-501-7238
Mailing Address - Fax:
Practice Address - Street 1:26544 66TH AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:MI
Practice Address - Zip Code:49065-8504
Practice Address - Country:US
Practice Address - Phone:269-501-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other