Provider Demographics
NPI:1003533753
Name:MCKENNA, JENNIFER LYNN (MA, CNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MA, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7886 ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MI
Mailing Address - Zip Code:48865-9761
Mailing Address - Country:US
Mailing Address - Phone:402-203-0861
Mailing Address - Fax:
Practice Address - Street 1:7886 ORLEANS RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MI
Practice Address - Zip Code:48865-9761
Practice Address - Country:US
Practice Address - Phone:402-203-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI80276673251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPA-0000030134OtherAUTO INS