Provider Demographics
NPI:1417201138
Name:MCCLEARY, JENNIFER L (ANP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8645 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:MI
Mailing Address - Zip Code:49021-9605
Mailing Address - Country:US
Mailing Address - Phone:269-240-6110
Mailing Address - Fax:
Practice Address - Street 1:11177 MICHIGAN AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8904
Practice Address - Country:US
Practice Address - Phone:269-660-5782
Practice Address - Fax:269-660-5793
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704198828363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health