Provider Demographics
NPI:1316247935
Name:EFAW, JENNIFFER MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:MARIE
Last Name:EFAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:615 N STATE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9702
Mailing Address - Country:US
Mailing Address - Phone:989-831-5237
Mailing Address - Fax:989-831-5522
Practice Address - Street 1:615 N STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-831-5237
Practice Address - Fax:989-831-3666
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47041871852083P0901X, 363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704187185OtherLICENSE - NURSE PRACTITIONER