Individual
MRS. JENELLE LYNN FYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 987-5000
Mailing address
3204 STRAWBERRY LN, PORT HURON, MI 48060-2306
(810) 334-9006
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704243706
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704243706
MI
Other
Enumeration date
08/17/2010
Last updated
06/29/2011
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