Provider Demographics
NPI:1942807441
Name:SENOPOLE, JESSICA (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SENOPOLE
Suffix:
Gender:F
Credentials:CNP
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:THIMG PRIMARY CARE- ROCHESTER HILLS
Practice Address - Street 2:1854 W. AUBURN RD STE 100A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309
Practice Address - Country:US
Practice Address - Phone:248-696-3170
Practice Address - Fax:248-696-3175
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2023-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704309945363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily