Basic Information
| Provider Information | |||||||||
| NPI: | 1215986914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONANT | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | DANNER | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5880 MCCRUM RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178799577 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2298 SPRINGPORT RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492021475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177843950 | ||||||||
| FaxNumber: | 5717832728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0509 P | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 5601005057 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1011463 | 05 | VT | MEDICAID | 30213617 | 05 | NH | MEDICAID | 7460555 | 01 | NH | AETNA | OTHER | 30332889 | 05 | NH | MEDICAID | 30513983 | 05 | NH | MEDICAID | 7459647 | 01 | NH | AETNA GROUP PROV NUMBER | OTHER | 0301819 | 05 | VT | MEDICAID | 8000921 | 01 | VT | LADIES FIRST PROV NUMBER | OTHER | 9000178 | 05 | VT | MEDICAID | RE8542 | 01 | NH | GROUP NHIC NUMBER | OTHER | 714276 | 01 | NH | MVP | OTHER | 00059932 | 01 | VT | BCBS OF VT | OTHER |