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General NPI Number Information
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NPI Number | 1518597079
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Entity Type | Individual
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Provider Name | JENNIFER SUZANNE HOLLENBACK LPN
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 236 CANDACE DR
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City | HARVEY
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State | MI
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Zip | 49855-9301
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Country | US
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Telephone | 906-249-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 485 HUSTLER ST
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City | GWINN
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State | MI
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Zip | 49841-2902
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Country | US
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Telephone | 906-361-4140
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703120314
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License Number State | MI
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