Healthcare Provider Details

I. General information

NPI: 1225410624
Provider Name (Legal Business Name): JENNIFER MURDZA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22611 BROOKDALE ST
FARMINGTON MI
48336-4119
US

IV. Provider business mailing address

1110 7TH AVE
CUMBERLAND WI
54829-9138
US

V. Phone/Fax

Practice location:
  • Phone: 248-495-6474
  • Fax:
Mailing address:
  • Phone: 715-822-7222
  • Fax: 715-822-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9786
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: