Healthcare Provider Details

I. General information

NPI: 1982052247
Provider Name (Legal Business Name): JENNIFER HOLSHOE CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7199 KALAMAZOO AVE SE STE 234
CALEDONIA MI
49316-7362
US

IV. Provider business mailing address

7199 KALAMAZOO AVE SE STE 234
CALEDONIA MI
49316-7362
US

V. Phone/Fax

Practice location:
  • Phone: 872-356-6880
  • Fax: 855-328-1381
Mailing address:
  • Phone: 872-356-6880
  • Fax: 855-328-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: