Provider Demographics
NPI:1831783349
Name:POWERS, JENNA (NP-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:429 EMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-2403
Mailing Address - Country:US
Mailing Address - Phone:313-770-3388
Mailing Address - Fax:
Practice Address - Street 1:1213 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2841
Practice Address - Country:US
Practice Address - Phone:313-278-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily