Healthcare Provider Details

I. General information

NPI: 1306117528
Provider Name (Legal Business Name): JENNIFER M DEUR R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W OAK ST
FREMONT MI
49412-1526
US

IV. Provider business mailing address

230 W OAK ST
FREMONT MI
49412-1526
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-4200
  • Fax: 231-924-4064
Mailing address:
  • Phone: 231-924-4200
  • Fax: 231-924-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704278814
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: