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General NPI Number Information
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NPI Number | 1467258160
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Entity Type | Individual
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Provider Name | JENNIFER WAWZYSKO AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 14231 BEADLE LAKE RD
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City | BATTLE CREEK
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State | MI
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Zip | 49014-8213
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Country | US
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Telephone | 269-962-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 31 MASON AVE S
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City | BATTLE CREEK
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State | MI
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Zip | 49037-1611
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Country | US
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Telephone | 269-753-4092
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704300786
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License Number State | MI
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