Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 7602000005 | MI |
NPI | 1114556990 |
---|---|
Provider Name | Jennifer Leigh Dewaard |
First Address | Caledonia, MI 49316-7341 |
Second Address | Caledonia, MI 49316-7341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2020 |
Last Update Date | 03/04/2020 |