Healthcare Provider Details

I. General information

NPI: 1366408551
Provider Name (Legal Business Name): WENDY K JAMROS RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 W LAKESHORE DR
BRIMLEY MI
49715-9319
US

IV. Provider business mailing address

12124 W LAKESHORE DR PO BOX 138
BRIMLEY MI
49715-9319
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-3241
  • Fax: 906-248-3376
Mailing address:
  • Phone: 906-248-3241
  • Fax: 906-248-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704182384
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: