Healthcare Provider Details

I. General information

NPI: 1902244833
Provider Name (Legal Business Name): JENNA M HEINERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA M FLETCHER

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E SHERMAN BLVD STE 2400
MUSKEGON MI
49444-1886
US

IV. Provider business mailing address

PO BOX 1847
MUSKEGON MI
49443-1847
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-6336
  • Fax: 231-672-6335
Mailing address:
  • Phone: 231-727-5211
  • Fax: 231-727-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101022963
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: