Provider Demographics
NPI:1154527786
Name:YOUNGLOVE, JENNIFER JEAN (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JEAN
Last Name:YOUNGLOVE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:MALKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:3601 WEST 13 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-8500
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-551-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704198960363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care