Basic Information
| Provider Information | |||||||||
| NPI: | 1790125391 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VILLAVICENCIO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | CLAIR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 SOUTH STATE STREET | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 EAST MEDICAL CENTER DRIVE | ||||||||
| Address2: | 9TH FLOOR VONVOIGTLANDER WOMENS HOSP RECP B | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481094276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347636295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301111670 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D90207 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.