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General NPI Number Information
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NPI Number | 1902194939
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Entity Type | Individual
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Provider Name | JOANNA LYNN GENDREAU D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 8132 TURNING STONE TRL
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City | KALAMAZOO
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State | MI
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Zip | 49009-8448
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Country | US
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Telephone | 330-605-4004
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Fax | 330-970-7090
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Provider Business Mailing Address
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Address Line | 8132 TURNING STONE TRL
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City | KALAMAZOO
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State | MI
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Zip | 49009-8448
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Country | US
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Telephone | 330-605-4004
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Fax | 330-970-7090
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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 | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 312665
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 006276
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 006276
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License Number State | AZ
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Taxonomy #4
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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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