Provider Demographics
NPI:1194894345
Name:ATTIE, JENNIFER HOLEM (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOLEM
Last Name:ATTIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 MITCHELL PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8965
Mailing Address - Country:US
Mailing Address - Phone:231-487-2250
Mailing Address - Fax:231-412-6360
Practice Address - Street 1:2390 MITCHELL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8965
Practice Address - Country:US
Practice Address - Phone:231-487-2250
Practice Address - Fax:231-412-6360
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704216431OtherSTATE LICENSE NUMBER