Provider Demographics
NPI:1437888112
Name:JENSHAK-GORZINSKI, CODI ANN (DNP)
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:ANN
Last Name:JENSHAK-GORZINSKI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N15887 S ROAD K
Mailing Address - Street 2:
Mailing Address - City:POWERS
Mailing Address - State:MI
Mailing Address - Zip Code:49874-9622
Mailing Address - Country:US
Mailing Address - Phone:906-399-5858
Mailing Address - Fax:
Practice Address - Street 1:N15887 S ROAD K
Practice Address - Street 2:
Practice Address - City:POWERS
Practice Address - State:MI
Practice Address - Zip Code:49874-9622
Practice Address - Country:US
Practice Address - Phone:906-399-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704334765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704334765Medicaid