Provider Demographics
NPI:1801251087
Name:KULESZA, JENNIFER (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KULESZA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:15031 RINALDI ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1207
Practice Address - Country:US
Practice Address - Phone:818-496-0006
Practice Address - Fax:818-847-4842
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2023-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA54427363A00000X
MI5601007635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant