Healthcare Provider Details

I. General information

NPI: 1669416079
Provider Name (Legal Business Name): HOLLY JENNIFER JASKIERNY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 GENESYS PKWY
GRAND BLANC MI
48439-2560
US

IV. Provider business mailing address

1620 GENESYS PKWY
GRAND BLANC MI
48439-2560
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-7190
  • Fax: 810-606-7186
Mailing address:
  • Phone: 810-606-7190
  • Fax: 810-606-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5101015227
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: