Provider Demographics
NPI:1598200552
Name:OUBRE, JENNEL
Entity Type:Individual
Prefix:
First Name:JENNEL
Middle Name:
Last Name:OUBRE
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 1:26114 PENN ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2641
Mailing Address - Country:US
Mailing Address - Phone:248-252-4798
Mailing Address - Fax:
Practice Address - Street 1:105 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2113
Practice Address - Country:US
Practice Address - Phone:248-252-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197050163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse