Provider Demographics
NPI:1891270237
Name:LOTARSKI, JENNIFER AARON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AARON
Last Name:LOTARSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 W PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2335
Mailing Address - Country:US
Mailing Address - Phone:313-205-0355
Mailing Address - Fax:
Practice Address - Street 1:21537 AUDETTE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3025
Practice Address - Country:US
Practice Address - Phone:313-205-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty