MEDICARE: JENNA DARWICHE

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1962136341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA DARWICHE

Provider Business Mailing Address
First Line	:	25880 TIMBER TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-4108
Country	:	US
Telephone Number	:	313-909-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E CYPRESS ST BLDG A
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4728
Country	:	US
Telephone Number	:	805-250-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	11/03/2024

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Directions to “ JENNA DARWICHE ” Practice Location

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