Provider Demographics
NPI:1386605897
Name:YEAMANS, JENNIFER M (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:YEAMANS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5970
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:3750 WOODWARD AVE
Practice Address - Street 2:STE 200C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2007
Practice Address - Country:US
Practice Address - Phone:313-993-4645
Practice Address - Fax:313-993-4654
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2013-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR119035367A00000X
MI4704256064367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLN9768706102OtherCAREFIRST
DCW6620164OtherCAREFIRST
MDK519L694Medicare ID - Type Unspecified
S64785Medicare UPIN
MI0P32150042Medicare PIN