MEDICARE: DR. JENNIFER KAY DULANEY D.O.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	5101022190	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N28430	OTHER	MI	GROUP MEDICARE PTAN

General Provider Information

NPI Number	:	1922445022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER KAY DULANEY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 1848
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49443-1848
Country	:	US
Telephone Number	:	231-672-2120
Fax Number	:	343-432-7758

Provider Business Practice Location Address
First Line	:	3570 HENRY ST STE 120
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-4576
Country	:	US
Telephone Number	:	231-672-7000
Fax Number	:	231-728-5041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	03/02/2021

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Directions to “ DR. JENNIFER KAY DULANEY D.O.” Practice Location

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