Provider Demographics
NPI:1790939585
Name:WOOLEY, JENNIFER R (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:WOOLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12701 TELEGRAPH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6847
Mailing Address - Country:US
Mailing Address - Phone:734-374-0500
Mailing Address - Fax:734-374-2415
Practice Address - Street 1:12701 TELEGRAPH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6847
Practice Address - Country:US
Practice Address - Phone:734-374-0500
Practice Address - Fax:734-374-2415
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704239555163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse