Healthcare Provider Details

I. General information

NPI: 1760702203
Provider Name (Legal Business Name): JENNIFER MICHELLE WOODMAN A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MICHELLE PARSONS A.N.P.

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR SUITE 209
TROY MI
48098-6365
US

IV. Provider business mailing address

4600 INVESTMENT DR SUITE 290
TROY MI
48098-6365
US

V. Phone/Fax

Practice location:
  • Phone: 248-267-5010
  • Fax:
Mailing address:
  • Phone: 248-267-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704248940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: