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General NPI Number Information
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NPI Number | 1043429095
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Entity Type | Individual
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Provider Name | JILL ANNE JENNINGS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 335 E HOUGHTON AVE
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City | WEST BRANCH
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State | MI
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Zip | 48661-1127
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Country | US
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Telephone | 989-343-3790
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 TEE LAKE RD
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City | WEST BRANCH
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State | MI
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Zip | 48661-9660
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Country | US
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Telephone | 989-343-6595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301085965
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License Number State | MI
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