Healthcare Provider Details

I. General information

NPI: 1194664672
Provider Name (Legal Business Name): JENA SALISBURY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 5TH ST NW
GRAND RAPIDS MI
49504-5163
US

IV. Provider business mailing address

865 5TH ST NW
GRAND RAPIDS MI
49504-5163
US

V. Phone/Fax

Practice location:
  • Phone: 586-596-1546
  • Fax:
Mailing address:
  • Phone: 586-596-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX6671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: