Provider Demographics
NPI:1548703218
Name:POLFUS, JENNI L (NP)
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:L
Last Name:POLFUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 US 2 AND 41
Mailing Address - Street 2:
Mailing Address - City:BARK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49807
Mailing Address - Country:US
Mailing Address - Phone:906-466-2000
Mailing Address - Fax:
Practice Address - Street 1:2845 US 2 AND 41
Practice Address - Street 2:
Practice Address - City:BARK RIVER
Practice Address - State:MI
Practice Address - Zip Code:49807
Practice Address - Country:US
Practice Address - Phone:906-466-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily