Provider Demographics
NPI:1194092445
Name:BURCHELL, JENNIFER ANN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:BURCHELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 POLLOCK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8395
Mailing Address - Country:US
Mailing Address - Phone:810-603-0170
Mailing Address - Fax:810-579-1705
Practice Address - Street 1:3399 POLLOCK RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8395
Practice Address - Country:US
Practice Address - Phone:810-603-0170
Practice Address - Fax:810-579-1705
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner