Healthcare Provider Details

I. General information

NPI: 1780590299
Provider Name (Legal Business Name): JENNA SLOT WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 ROMENCE RD
PORTAGE MI
49024-3613
US

IV. Provider business mailing address

9476 TIGER LILY DR SE
CALEDONIA MI
49316-8082
US

V. Phone/Fax

Practice location:
  • Phone: 269-218-1232
  • Fax:
Mailing address:
  • Phone: 616-901-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704316604
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: