Most Relevant Information
Provider Data
| NPI Number: | 1003475344 |
| Provider Name: | JENNY M BAUSANO FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 4704259562 |
Most Important Dates
| Enumeration Date: | 06/11/2019 |
| Last Updated: | 04/14/2021 |
Provider Practice Location
945 9TH ST
LAKE LINDEN
MI
499451100
Practice Location Phone/Fax
| Phone: | 9064831030 |
| Fax: |
Provider Mailing Location
301 EXPLORER ST
GWINN
MI
498412813
Provider Mailing Phone/Fax
| Phone: | 9063464924 |
| Fax: | 9063466474 |