Provider Demographics
NPI:1396190070
Name:KLENNER, MARGARET (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:KLENNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:MATLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:248-764-3094
Mailing Address - Fax:
Practice Address - Street 1:15959 HALL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5363
Practice Address - Country:US
Practice Address - Phone:586-884-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13806212OtherCAQH