Provider Demographics
NPI:1851034359
Name:KISS, JENNA SUE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:SUE
Last Name:KISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W GROVE CT
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-7804
Mailing Address - Country:US
Mailing Address - Phone:989-295-2383
Mailing Address - Fax:
Practice Address - Street 1:9 W GROVE CT
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-7804
Practice Address - Country:US
Practice Address - Phone:989-295-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician