Healthcare Provider Details

I. General information

NPI: 1629586268
Provider Name (Legal Business Name): JENNIFER NASH, MD DERMATOLOGY ASSOCIATES OF MIDLAND, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 W WACKERLY ST
MIDLAND MI
48640-6922
US

IV. Provider business mailing address

2711 W WACKERLY ST
MIDLAND MI
48640-6922
US

V. Phone/Fax

Practice location:
  • Phone: 989-837-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax: 989-837-6837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER NASH
Title or Position: PHYSICIAN
Credential: MD
Phone: 989-750-2641