Individual
MRS. JOANNE LOIS JEPSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
2100 RAYBROOK AVE SE, SUITE 300, GRAND RAPIDS, MI 49546
(616) 340-9763
Mailing address
2100 RAYBROOK AVE SE, SUITE 300, GRAND RAPIDS, MI 49546
(616) 340-9763
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704177140
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153161730
—
MI
Enumeration date
01/06/2010
Last updated
05/01/2012
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