Healthcare Provider Details

I. General information

NPI: 1518443514
Provider Name (Legal Business Name): JENNIFER CHURCHILL MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WATKINS

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 400
LANSING MI
48912-1806
US

IV. Provider business mailing address

804 SERVICE RD STE A109F
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9650
  • Fax: 517-364-9605
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704295307
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704295307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: