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General NPI Number Information
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NPI Number | 1609214972
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Entity Type | Individual
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Provider Name | JENNIFER LYNN KRISHNAN M.S. PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 3601 E 13 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-6769
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Country | US
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Telephone | 248-898-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 915 N ALEXANDER AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3607
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Country | US
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Telephone | 313-318-9590
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5601006682
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License Number State | MI
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