Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 4704223063 | MI |
N | 363LW0102X | Nurse Practitioner - Women's Health | 4704223063 | MI |
NPI | 1073830428 |
---|---|
Provider Name | Mrs. Jennifer Ann Dentler |
First Address | Allegan, MI 49010-1595 |
Second Address | Allegan, MI 49010-1595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 10/04/2014 |