Provider Demographics
NPI:1598091704
Name:ROHRBORN, JENNIFER CAROL (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CAROL
Last Name:ROHRBORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26025 LAHSER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2606
Mailing Address - Country:US
Mailing Address - Phone:248-663-1900
Mailing Address - Fax:248-663-1901
Practice Address - Street 1:32605 W 12 MILE RD STE 195
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3390
Practice Address - Country:US
Practice Address - Phone:313-306-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196918363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704196918OtherMICHIGAN LICENSE