Healthcare Provider Details

I. General information

NPI: 1295661940
Provider Name (Legal Business Name): JENNIFER LEE BADOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

IV. Provider business mailing address

4170 S LOOMIS RD
SHEPHERD MI
48883-8063
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-3058
  • Fax:
Mailing address:
  • Phone: 989-621-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704359015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: