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NPI Code Detail

MEDICARE: JESSICA STARR GREVENSTUK NP

MEDICARE: JESSICA STARR GREVENSTUK NP
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
1363LG0600XGerontology Nurse Practitioner4704257219MI

General Provider Information

NPI Number : 1588098685
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA STARR GREVENSTUK NP
Provider Business Mailing Address
First Line : 3235 N WELLNESS DR STE 120B
Second Line :
City : HOLLAND
State : MI
Zip : 49424-8035
Country : US
Telephone Number : 616-399-9522
Fax Number :
Provider Business Practice Location Address
First Line : 3200 GREENFIELD RD STE 300
Second Line :
City : DEARBORN
State : MI
Zip : 48120-1805
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2013
Last Update Date : 03/12/2025

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