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General NPI Number Information
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NPI Number | 1649752742
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Entity Type | Individual
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Provider Name | JENNIFER MCCONNELL DNP,FNP-C,PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 105 PEARL ST
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City | YPSILANTI
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State | MI
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Zip | 48197-2611
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Country | US
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Telephone | 734-275-3955
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Fax |
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Provider Business Mailing Address
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Address Line | 29601 TRANCREST ST
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City | LIVONIA
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State | MI
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Zip | 48152-4533
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Country | US
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Telephone | 248-231-7079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704247043
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704247043
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License Number State | MI
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