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General NPI Number Information
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NPI Number | 1083972434
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Entity Type | Individual
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Provider Name | JENNIFER EDWARDS-JOHNSON D.O
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1200 E MICHIGAN AVE STE 245A
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City | LANSING
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State | MI
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Zip | 48912-1852
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Country | US
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Telephone | 517-364-5710
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Fax | 517-264-5717
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Provider Business Mailing Address
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Address Line | 13820 COURTLAND ST
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City | OAK PARK
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State | MI
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Zip | 48237-2723
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Country | US
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Telephone | 517-420-3045
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101019898
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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