Provider Demographics
NPI:1477619518
Name:PFEIFFER, JENNIFER MARIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MARIE
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:34862 HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4446
Mailing Address - Country:US
Mailing Address - Phone:847-863-6456
Mailing Address - Fax:
Practice Address - Street 1:6576 CHELSEA BRG
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3072
Practice Address - Country:US
Practice Address - Phone:313-567-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant