Jennipher Lynn Gibbons
Individual provider Active NPI Custodial Care Facility · Edmore, MI
NPI 1609595024 · NPPES record last updated Aug 29, 2022
Key facts
- NPI
- 1609595024
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Custodial Care Facility 311Z00000X
- License
- AF590409770 (MI)
- Practice address
- 1850 W Michigan Ave
Edmore, MI 48829-9376 - Phone
- (989) 560-1301
- NPI assigned
- Aug 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AF590409770 | MI | MD | Custodial Care Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Custodial Care Facility | 311Z00000X | AF590409770 | MI | Yes |
Addresses
Primary practice location
1850 W Michigan Ave
Edmore, MI 48829-9376
Mailing address
1850 W Michigan Ave
Edmore, MI 48829-9376
Phone (989) 560-1301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | NA |
Other providers in Edmore, MI
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- Ralph Robert Elsner
- Carol Ann Evans
- Martha N Gichia
- Grand B1
- Great Lakes Medical Associates, PC
- Halsey Family Chiropractic, PLLC
- Jared L Halsey
All providers in Edmore, MI · Custodial Care Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.