Individual
JENNIPHER LYNN GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1850 W MICHIGAN AVE, EDMORE, MI 48829-9376
(989) 560-1301
Mailing address
1850 W MICHIGAN AVE, EDMORE, MI 48829-9376
(989) 560-1301
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
AF590409770
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
08/29/2022
Last updated
08/29/2022
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