Provider Demographics
NPI:1295018125
Name:NEWTON, JENNIFER ELAINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8285 IRONSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8673
Mailing Address - Country:US
Mailing Address - Phone:231-903-3878
Mailing Address - Fax:
Practice Address - Street 1:4100 EMBASSY DR SE
Practice Address - Street 2:#400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2416
Practice Address - Country:US
Practice Address - Phone:616-988-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant