Healthcare Provider Details

I. General information

NPI: 1871182485
Provider Name (Legal Business Name): JENNIFER ANN MCGRAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 DEERFIELD RD
ADRIAN MI
49221-9601
US

IV. Provider business mailing address

100 POWELL DR
DUNDEE MI
48131-8644
US

V. Phone/Fax

Practice location:
  • Phone: 517-442-6714
  • Fax: 517-266-1530
Mailing address:
  • Phone: 517-266-1481
  • Fax: 517-266-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4356888
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: