Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 4704205361 | MI |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704205361 | MI |
NPI | 1235337809 |
---|---|
Provider Name | Mrs. Jennnifer Beth Farnsworth |
First Address | Marquette, MI 49855-2705 |
Second Address | Marquette, MI 49855-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 17/02/2010 |