Provider Demographics
NPI:1336383660
Name:DAVID, JENNY K (FNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:K
Last Name:DAVID
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 1:343 EAST STATE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661
Mailing Address - Country:US
Mailing Address - Phone:989-345-4967
Mailing Address - Fax:
Practice Address - Street 1:5170 RIFLE RIVER TRL
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:MI
Practice Address - Zip Code:48610-9343
Practice Address - Country:US
Practice Address - Phone:989-873-5323
Practice Address - Fax:989-873-3673
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224697363LC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health