Provider Demographics
NPI:1629486196
Name:PRAY, JENNIFER (PA)
Entity Type:Individual
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First Name:JENNIFER
Middle Name:
Last Name:PRAY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8292
Practice Address - Country:US
Practice Address - Phone:616-267-7100
Practice Address - Fax:616-267-7137
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2021-02-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant