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NPI Code Detail

MEDICARE: JILL NORENE POLMATEER N.P.

MEDICARE: JILL NORENE POLMATEER N.P.
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
1363LF0000XFamily Nurse Practitioner4704155176MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15008700740OTHERMIBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730157652
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL NORENE POLMATEER N.P.
Provider Business Mailing Address
First Line : 1104 CASS ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3236
Country : US
Telephone Number : 231-941-1155
Fax Number : 231-941-1347
Provider Business Practice Location Address
First Line : 1104 CASS ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3236
Country : US
Telephone Number : 231-941-1155
Fax Number : 231-941-1347
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 09/30/2016

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Directions to “ JILL NORENE POLMATEER N.P.” Practice Location

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