Provider Demographics
NPI:1114799319
Name:PANNEBECKER, JENNA (PAC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PANNEBECKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43740 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1122
Mailing Address - Country:US
Mailing Address - Phone:586-349-1154
Mailing Address - Fax:
Practice Address - Street 1:26672 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1222
Practice Address - Country:US
Practice Address - Phone:586-756-7670
Practice Address - Fax:586-228-9019
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-12-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant