Provider Demographics
NPI:1336692532
Name:ZACHARY, JENNIFER (A-GNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32825 ZINFANDEL AVE
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1848
Mailing Address - Country:US
Mailing Address - Phone:269-591-0938
Mailing Address - Fax:
Practice Address - Street 1:6565 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9144
Practice Address - Country:US
Practice Address - Phone:269-375-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285393363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health