MEDICARE: MS. JENNIFER ELAINE NEWTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601006206	MI

General Provider Information

NPI Number	:	1295018125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ELAINE NEWTON PA-C

Provider Business Mailing Address
First Line	:	8285 IRONSTONE AVE
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8673
Country	:	US
Telephone Number	:	231-903-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 EMBASSY DR SE
Second Line	:	#400
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2416
Country	:	US
Telephone Number	:	616-988-8220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	08/09/2016

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