Provider Demographics
NPI:1770830366
Name:AHLQUIST, JENNIFER MARIE (MSN, CNP, ANP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:AHLQUIST
Suffix:
Gender:F
Credentials:MSN, CNP, ANP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:555 W 14 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3100
Mailing Address - Country:US
Mailing Address - Phone:248-655-1400
Mailing Address - Fax:248-655-2646
Practice Address - Street 1:555 W 14 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-3100
Practice Address - Country:US
Practice Address - Phone:248-655-1400
Practice Address - Fax:248-655-2646
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704284307363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health