Provider Demographics
NPI:1487106431
Name:JENNIE M HUNNEWELL MD PLLC
Entity type:Organization
Organization Name:JENNIE M HUNNEWELL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUNNEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-409-8369
Mailing Address - Street 1:5709 ROSEBAY CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-1812
Mailing Address - Country:US
Mailing Address - Phone:405-463-5700
Mailing Address - Fax:
Practice Address - Street 1:5101 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2018
Practice Address - Country:US
Practice Address - Phone:405-463-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20314208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty