Individual
MARY K JENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4005 ORCHARD DR, MIDLAND, MI 48670-0001
(989) 839-3000
Mailing address
3519 E POINT DR, BEAVERTON, MI 48612-8742
(989) 435-8890
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704159661
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3294932
—
MI
01
—
MJ159661
BLUE SHIELD
MI
Enumeration date
10/13/2006
Last updated
07/09/2007
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