Provider Demographics
NPI:1720535420
Name:LINCOLN, JENNA NICOLE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:NICOLE
Other - Last Name:SWARTSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5409 DURWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1166
Mailing Address - Country:US
Mailing Address - Phone:810-597-7430
Mailing Address - Fax:
Practice Address - Street 1:5409 DURWOOD DR
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1166
Practice Address - Country:US
Practice Address - Phone:810-597-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other