Healthcare Provider Details

I. General information

NPI: 1235337809
Provider Name (Legal Business Name): JENNNIFER BETH FARNSWORTH MSN, RNC-NIC, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2705
US

IV. Provider business mailing address

580 W COLLEGE AVE
MARQUETTE MI
49855-2705
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4686
  • Fax: 190-622-5719
Mailing address:
  • Phone: 906-225-4626
  • Fax: 190-622-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number4704205361
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number4704205361
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4704205361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: