| Doctor Name: | JENNIFER MARIE AHLQUIST |
| NPI Number: | 1770830366 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, CNP, ANP-BC |
| License Number: | 4704284307 |
| Business Practice Address: | 555 W 14 Mile Rd Suite 100 Clawson, MI - 480173100 |
| Business Phone Number: | 2486551400 |
| Business Fax Number: | 2486552646 |
| Mailing Address: | 555 W 14 Mile Rd, Suite 100 CLAWSON |
| State: | MI |
| Postal Code: | 480173100 |
| Phone Number: | 2486551400 |
| Fax Number: | 2486552646 |
| NPI Enumeration Date: | 08/14/2012 |
| NPI Last Update Date: | 08/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704284307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |