Healthcare Provider Details

I. General information

NPI: 1912072018
Provider Name (Legal Business Name): JILL ANN STEFFKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ANN COOK RN

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRAL MICHIGAN UNIVERSITY HEALTH SERVICES FOUST HALL 108
MT PLEASANT MI
48859-0001
US

IV. Provider business mailing address

4240 W WEIDMAN RD
WEIDMAN MI
48893-9717
US

V. Phone/Fax

Practice location:
  • Phone: 989-774-1748
  • Fax: 989-774-4335
Mailing address:
  • Phone: 989-644-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number4704168232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: