Provider Demographics
NPI:1164556494
Name:LALONDE, JEANNINE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:
Last Name:LALONDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 TOWNLINE 17 RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48613-9654
Mailing Address - Country:US
Mailing Address - Phone:989-846-4521
Mailing Address - Fax:989-846-3541
Practice Address - Street 1:805 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9526
Practice Address - Country:US
Practice Address - Phone:989-846-4521
Practice Address - Fax:989-846-3541
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601002602OtherLICENSE