Individual
JASON FENNEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 391-1609
Mailing address
13348 HIDDEN CREEK DR, GRAND HAVEN, MI 49417-8964
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704279909
MI
Other
Enumeration date
01/24/2017
Last updated
01/26/2024
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