Healthcare Provider Details

I. General information

NPI: 1548795800
Provider Name (Legal Business Name): JENELLE KALVODA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENELLE JODOIN RN

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 GRAND RIVER RD
BRIGHTON MI
48116-8506
US

IV. Provider business mailing address

12851 GRAND RIVER RD
BRIGHTON MI
48116-8506
US

V. Phone/Fax

Practice location:
  • Phone: 877-976-2371
  • Fax:
Mailing address:
  • Phone: 877-976-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704259852
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704259852
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: