Healthcare Provider Details

I. General information

NPI: 1467258160
Provider Name (Legal Business Name): JENNIFER WAWZYSKO AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14231 BEADLE LAKE RD
BATTLE CREEK MI
49014-8213
US

IV. Provider business mailing address

31 MASON AVE S
BATTLE CREEK MI
49037-1611
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-0441
  • Fax:
Mailing address:
  • Phone: 269-753-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704300786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: