Healthcare Provider Details

I. General information

NPI: 1336692532
Provider Name (Legal Business Name): JENNIFER ZACHARY A-GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W MAIN ST STE 100
KALAMAZOO MI
49009-9144
US

IV. Provider business mailing address

32825 ZINFANDEL AVE
PAW PAW MI
49079-1848
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-0400
  • Fax:
Mailing address:
  • Phone: 269-591-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704285393
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: