Provider Demographics
NPI:1760702203
Name:WOODMAN, JENNIFER MICHELLE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5010
Mailing Address - Fax:
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 209
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-267-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248940363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health