Healthcare Provider Details

I. General information

NPI: 1386605897
Provider Name (Legal Business Name): JENNIFER M YEAMANS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 WOODWARD AVE STE 200C
DETROIT MI
48201-2007
US

IV. Provider business mailing address

1420 STEPHENSON HWY SUITE 400-CREDENTIALING
TROY MI
48083-1189
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-4645
  • Fax: 313-993-4654
Mailing address:
  • Phone: 248-581-5970
  • Fax: 248-581-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR119035
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704256064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: