Provider Demographics
NPI:1851361711
Name:JENNINGS, NADINE S (MD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:S
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:S
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:42557 WOODWARD AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-322-3088
Mailing Address - Fax:248-322-4175
Practice Address - Street 1:2300 HAGGERTY RD STE 2150A
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2192
Practice Address - Country:US
Practice Address - Phone:248-926-6610
Practice Address - Fax:248-926-6611
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059614208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104851960Medicaid
MI0634908OtherBCBSM
MI5549289OtherAETNA
MI0634908OtherBCBSM
MIG29434Medicare UPIN
MI0634908OtherBCBSM
MI700F318300OtherBLUE CROSS BLUE SHIELD