Provider Demographics
NPI:1487208708
Name:ERNO, JEANETTE LYNN
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:LYNN
Last Name:ERNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 SUNTERRA TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9025
Mailing Address - Country:US
Mailing Address - Phone:231-459-6711
Mailing Address - Fax:
Practice Address - Street 1:1548 SUNTERRA TRL
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9025
Practice Address - Country:US
Practice Address - Phone:231-459-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE650385564295344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi