Provider Demographics
NPI:1114745833
Name:ALLEN, JENNA MARIE (RN, NP-BC)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN, NP-BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:CHIAMPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23542 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2247
Mailing Address - Country:US
Mailing Address - Phone:313-467-7621
Mailing Address - Fax:
Practice Address - Street 1:23542 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2247
Practice Address - Country:US
Practice Address - Phone:313-467-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44704297461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse