Provider Demographics
NPI:1770250714
Name:FORD, JENNIFER LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A108B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-9385
Mailing Address - Fax:517-353-9421
Practice Address - Street 1:1200 E MICHIGAN AVE STE 145
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1897
Practice Address - Country:US
Practice Address - Phone:517-353-9385
Practice Address - Fax:517-353-9421
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704226493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily