Provider Demographics
NPI:1063056430
Name:HOWE, JACQUELINE LANE KENDALL (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LANE KENDALL
Last Name:HOWE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27725 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3663
Mailing Address - Country:US
Mailing Address - Phone:248-424-7124
Mailing Address - Fax:
Practice Address - Street 1:27725 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3663
Practice Address - Country:US
Practice Address - Phone:248-424-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily