Provider Demographics
NPI:1417311291
Name:JANKOWSKI, RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DEER CRK
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-3615
Mailing Address - Country:US
Mailing Address - Phone:810-357-4148
Mailing Address - Fax:
Practice Address - Street 1:400 DEER CRK
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-3615
Practice Address - Country:US
Practice Address - Phone:810-357-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704221653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily