Provider Demographics
NPI:1730688904
Name:ROUPE, JENNIFER MARLENE MARIE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARLENE MARIE
Last Name:ROUPE
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 1:8305 S SAGINAW ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1894
Mailing Address - Country:US
Mailing Address - Phone:810-606-8400
Mailing Address - Fax:
Practice Address - Street 1:8305 S SAGINAW ST STE 1
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1894
Practice Address - Country:US
Practice Address - Phone:810-606-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid