Healthcare Provider Details

I. General information

NPI: 1851208326
Provider Name (Legal Business Name): JENNIFER IRVINE-LEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FERRIS DR
BIG RAPIDS MI
49307-2716
US

IV. Provider business mailing address

7902 ROBERTSON RUN NE
ROCKFORD MI
49341-8768
US

V. Phone/Fax

Practice location:
  • Phone: 231-591-2260
  • Fax:
Mailing address:
  • Phone: 616-318-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: