Provider Demographics
NPI:1699066852
Name:COPE, JENNA MARIE
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:MARIE
Last Name:COPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 VENTURE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1858
Mailing Address - Country:US
Mailing Address - Phone:269-532-1470
Mailing Address - Fax:269-532-1472
Practice Address - Street 1:5990 VENTURE PARK DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1858
Practice Address - Country:US
Practice Address - Phone:269-532-1470
Practice Address - Fax:269-532-1472
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist