Healthcare Provider Details

I. General information

NPI: 1982052247
Provider Name (Legal Business Name): JENNIFER HOLSHOE CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 LEONARD ST
MARNE MI
49435-9723
US

IV. Provider business mailing address

4361 LEONARD ST
MARNE MI
49435-9723
US

V. Phone/Fax

Practice location:
  • Phone: 616-219-0618
  • Fax: 904-592-5267
Mailing address:
  • Phone: 616-318-1825
  • Fax: 904-592-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: