MEDICARE: JACLYN WEBER PA

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	5601010586	MI

General Provider Information

NPI Number	:	1992371702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN WEBER PA

Provider Business Mailing Address
First Line	:	16825 ABBY CIR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48168-4303
Country	:	US
Telephone Number	:	248-444-9097
Fax Number	:

Provider Business Practice Location Address
First Line	:	17901 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-3200
Country	:	US
Telephone Number	:	734-315-7070
Fax Number	:

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

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	04/14/2022

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Directions to “ JACLYN WEBER PA” Practice Location

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