Jennifer L Connell, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

470424233 Issued in MI

Practice address

3399 Pollock Rd
Grand Blanc, MI 48439-8395

Phone

(810) 603-0170

Fax

(810) 603-2370

NPI assigned

May 12, 2010

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  Medicare reassignment NPD
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  • Cardiac Rehabilitation Clinic/Center
  • Flushing, MI
  • NPI 1912549056
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1578881827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3399 POLLOCK RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398395",
            "telephone_number": "810-603-0170",
            "fax_number": "810-579-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3399 POLLOCK RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398395",
            "telephone_number": "810-603-0170",
            "fax_number": "810-603-2370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 S Linden Rd",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485325475",
            "country_code": "US",
            "telephone_number": "810-733-0790",
            "fax_number": "810-733-1817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNELL",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "470424233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "470424233",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS STATE LICENSE",
            "identifier": "JC24233",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.