Provider Demographics
NPI:1467258160
Name:WAWZYSKO, JENNIFER (AGNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WAWZYSKO
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MASON AVE S
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-1611
Mailing Address - Country:US
Mailing Address - Phone:269-753-4092
Mailing Address - Fax:
Practice Address - Street 1:14231 BEADLE LAKE RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8213
Practice Address - Country:US
Practice Address - Phone:269-962-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300786363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care