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General NPI Number Information
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NPI Number | 1063361343
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Entity Type | Individual
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Provider Name | SCOTT JENNER
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Gender | Male
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 22745 KELLY RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2047
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Country | US
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Telephone | 586-779-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 29939 SUGAR CREEK DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5703
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704378952
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License Number State | MI
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