Provider Demographics
NPI:1669416079
Name:JASKIERNY, HOLLY JENNIFER (DO)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JENNIFER
Last Name:JASKIERNY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1620 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2560
Mailing Address - Country:US
Mailing Address - Phone:810-606-7190
Mailing Address - Fax:810-606-7186
Practice Address - Street 1:1620 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2560
Practice Address - Country:US
Practice Address - Phone:810-606-7190
Practice Address - Fax:810-606-7186
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015227207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01003097OtherHEALTH PLUS OF MI
MI7049860OtherAETNA
MII60137OtherHEALTH ALLIANCE PLAN
MI01003097OtherGENESEE HEALTH PLAN
MIBCBSOther160B511630
MIBLUECARE NETWORKOther160B511630
MI4928770Medicaid
MI17635OtherMCARE
MI382626196OtherPPOM
MI38895OtherHEALTH PLAN OF MI
MIBCBSOther160B511630
MIP10950002Medicare ID - Type Unspecified
MI4928770Medicaid