Provider Demographics
NPI:1144978818
Name:GOWAN, JENNIFER (CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:GOWAN
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 OLDE SAYBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8728
Mailing Address - Country:US
Mailing Address - Phone:810-623-9934
Mailing Address - Fax:
Practice Address - Street 1:5297 OLDE SAYBROOKE CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8728
Practice Address - Country:US
Practice Address - Phone:810-623-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty