Provider Demographics
NPI:1295035244
Name:MCDONOUGH, JEAN M (FNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:14700 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1931
Mailing Address - Country:US
Mailing Address - Phone:231-547-8516
Mailing Address - Fax:231-547-8088
Practice Address - Street 1:3434 M 119
Practice Address - Street 2:SUITE C
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9373
Practice Address - Country:US
Practice Address - Phone:231-348-9900
Practice Address - Fax:989-358-3780
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2021-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704173385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIZ16001085Medicare PIN