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NPI Code Detail

MEDICARE: JESSICA AC JUDY NP-C

MEDICARE: JESSICA AC JUDY NP-C
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
1363L00000XNurse Practitioner4704220408MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15008750240OTHERMIBLUE CROSS BLUE SHIELD MI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730163932
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA AC JUDY NP-C
Provider Business Mailing Address
First Line : PO BOX 220
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-0220
Country : US
Telephone Number : 906-225-4821
Fax Number : 906-225-4537
Provider Business Practice Location Address
First Line : 800 EAST BLVD
Second Line :
City : KINGSFORD
State : MI
Zip : 49802-4436
Country : US
Telephone Number : 906-774-4000
Fax Number : 906-774-0088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 02/25/2008

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Directions to “ JESSICA AC JUDY NP-C” Practice Location

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