Provider Demographics
NPI:1932970266
Name:ISHAM, JENNA MARIE (DNP, FNP- BC)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:ISHAM
Suffix:
Gender:F
Credentials:DNP, FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4714
Mailing Address - Country:US
Mailing Address - Phone:248-643-0044
Mailing Address - Fax:
Practice Address - Street 1:2649 CROOKS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4714
Practice Address - Country:US
Practice Address - Phone:248-643-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317155163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse