=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497611768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ROSARIO ALEJAGA
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1939 SANDREL DR NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49505-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-734-7684
-----------------------------------------------------
Fax | 616-734-7684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1939 SANDREL DR NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49505-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-734-7684
-----------------------------------------------------
Fax | 616-734-7684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 4704323530NSA2511G
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------