Provider Demographics
NPI:1558812768
Name:JENNINGS, DEVON EILEEN (PA)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:EILEEN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24345 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1285
Mailing Address - Country:US
Mailing Address - Phone:586-563-3300
Mailing Address - Fax:586-563-3313
Practice Address - Street 1:24345 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1285
Practice Address - Country:US
Practice Address - Phone:586-563-3300
Practice Address - Fax:586-563-3313
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical