MEDICARE: MRS. JENNA ELIZABETH KLUMP FNP-C

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	363LP2300X	Primary Care Nurse Practitioner	4704324125	MI

General Provider Information

NPI Number	:	1629563135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA ELIZABETH KLUMP FNP-C

Provider Business Mailing Address
First Line	:	9050 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1608
Country	:	US
Telephone Number	:	734-850-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	9050 LEWIS AVE
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1608
Country	:	US
Telephone Number	:	734-850-8902
Fax Number	:

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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