Provider Demographics
NPI:1215986914
Name:CONANT, JEFFREY DANNER (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANNER
Last Name:CONANT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 MCCRUM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-879-9577
Mailing Address - Fax:
Practice Address - Street 1:2298 SPRINGPORT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1475
Practice Address - Country:US
Practice Address - Phone:517-784-3950
Practice Address - Fax:571-783-2728
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0509 P363A00000X
MI5601005057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011463Medicaid
NH30213617Medicaid
NH7460555OtherAETNA
NH30332889Medicaid
NH30513983Medicaid
NH7459647OtherAETNA GROUP PROV NUMBER
VT0301819Medicaid
VT8000921OtherLADIES FIRST PROV NUMBER
VT9000178Medicaid
NHRE8542OtherGROUP NHIC NUMBER
NH714276OtherMVP
VT00059932OtherBCBS OF VT
NH303817Medicare ID - Type UnspecifiedGROUP RHC MEDICARE NUMBER
NH30513983Medicaid
VT1011463Medicaid