Provider Demographics
NPI:1548244387
Name:HUNNEWELL, JENNIE M (MD PLLC)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:M
Last Name:HUNNEWELL
Suffix:
Gender:F
Credentials:MD PLLC
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Other - Credentials:
Mailing Address - Street 1:5025 GAILLARDIA CORPORATE PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-1888
Mailing Address - Country:US
Mailing Address - Phone:405-463-5700
Mailing Address - Fax:405-463-5705
Practice Address - Street 1:5101 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2018
Practice Address - Country:US
Practice Address - Phone:405-463-5700
Practice Address - Fax:405-463-5705
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2023-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK20314207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG43589Medicare UPIN