| Doctor Name: | JENNIFER SHAWN EDGAR |
| NPI Number: | 1013107366 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, BC |
| License Number: | 4704197458 |
| Business Practice Address: | 731 Starkweather Dr Lansing, MI - 489171128 |
| Business Phone Number: | 7344640887 |
| Business Fax Number: | 7344020254 |
| Mailing Address: | 36123 Schoolcraft Rd, LIVONIA |
| State: | MI |
| Postal Code: | 481501216 |
| Phone Number: | 7344640887 |
| Fax Number: | 7344020254 |
| NPI Enumeration Date: | 08/01/2007 |
| NPI Last Update Date: | 09/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 4704197458 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |