Healthcare Provider Details

I. General information

NPI: 1518795632
Provider Name (Legal Business Name): JENNIFER WINELAND OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 SPRING ARBOR RD
JACKSON MI
49203-3601
US

IV. Provider business mailing address

2555 SPRING ARBOR RD
JACKSON MI
49203-3601
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-5210
  • Fax:
Mailing address:
  • Phone: 517-787-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902015642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: