Provider Demographics
NPI:1972073807
Name:MCCUMMINGS, JENNA M (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:MCCUMMINGS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:ONWELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:439 S ROSS ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-9101
Mailing Address - Country:US
Mailing Address - Phone:989-246-3500
Mailing Address - Fax:
Practice Address - Street 1:439 S ROSS ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-9101
Practice Address - Country:US
Practice Address - Phone:989-246-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275966363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care