Healthcare Provider Details

I. General information

NPI: 1225467509
Provider Name (Legal Business Name): JENNIFER TRAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30061 SCHOENHERR RD
WARREN MI
48088-3133
US

IV. Provider business mailing address

30061 SCHOENHERR RD
WARREN MI
48088-3133
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-2111
  • Fax: 586-558-2169
Mailing address:
  • Phone: 586-558-2111
  • Fax: 586-558-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704154002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: