Provider Demographics
NPI:1568932101
Name:JANNENGA, STEPHANI DANIELLE
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:DANIELLE
Last Name:JANNENGA
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 1:565 W. WESTERN AVE.
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440
Mailing Address - Country:US
Mailing Address - Phone:231-672-3201
Mailing Address - Fax:231-672-8404
Practice Address - Street 1:565 W. WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440
Practice Address - Country:US
Practice Address - Phone:231-672-3201
Practice Address - Fax:231-672-8404
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker