Healthcare Provider Details

I. General information

NPI: 1326432048
Provider Name (Legal Business Name): JESSICA BISCHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA COOK

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-1644
  • Fax: 989-839-3029
Mailing address:
  • Phone: 989-839-1644
  • Fax: 989-839-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: