MEDICARE: JENNIFER ROSARIO ALEJAGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	4704323530NSA2511G	MI

General Provider Information

NPI Number	:	1497611768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSARIO ALEJAGA

Provider Business Mailing Address
First Line	:	1939 SANDREL DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-7300
Country	:	US
Telephone Number	:	616-734-7684
Fax Number	:

Provider Business Practice Location Address
First Line	:	8911 N CAPITAL OF TEXAS HWY STE 1110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-7203
Country	:	US
Telephone Number	:	877-279-5960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	01/22/2026

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