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NPI Code Detail

MEDICARE: MR. JARED JENNINGS POPPEN RN

MEDICARE: MR. JARED JENNINGS POPPEN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4704328954MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704328954OTHERMIRN LICENSE NUMBER

General Provider Information

NPI Number : 1417587072
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JARED JENNINGS POPPEN RN
Provider Business Mailing Address
First Line : 456 BALTIMORE DR NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-3934
Country : US
Telephone Number : 616-301-8000
Fax Number :
Provider Business Practice Location Address
First Line : 440 BALTIMORE DR NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-3934
Country : US
Telephone Number : 616-301-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2020
Last Update Date : 03/07/2023

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