1669416079 NPI number — HOLLY JENNIFER JASKIERNY D.O.

Table of content: TRACY A LOWN PA-C (NPI 1518969922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669416079 NPI number — HOLLY JENNIFER JASKIERNY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JASKIERNY
Provider First Name:
HOLLY
Provider Middle Name:
JENNIFER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669416079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 GENESYS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-606-7190
Provider Business Mailing Address Fax Number:
810-606-7186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 GENESYS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-606-7190
Provider Business Practice Location Address Fax Number:
810-606-7186
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  5101015227 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01003097 . This is a "HEALTH PLUS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7049860 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: I60137 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01003097 . This is a "GENESEE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: BCBS . This is a "160B511630" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: BLUECARE NETWORK . This is a "160B511630" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4928770 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17635 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 382626196 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 38895 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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