Healthcare Provider Details

I. General information

NPI: 1689116568
Provider Name (Legal Business Name): CARRIE ANN JUREK R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20106 STATE HIGHWAY M-28 MCDC EWEN
EWEN MI
49925
US

IV. Provider business mailing address

20106 STATE HWY M-28 MCDC EWEN
EWEN MI
49925
US

V. Phone/Fax

Practice location:
  • Phone: 906-988-2000
  • Fax: 906-988-2206
Mailing address:
  • Phone: 906-988-2000
  • Fax: 906-988-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902017686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: