Individual
JENNIFER LYNN JENNINGS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4646 JOHN R, DETROIT, MI 48201
(313) 576-3966
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
(734) 626-3894
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703083772
MI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
4703083772
MI
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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