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General NPI Number Information
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NPI Number | 1003464397
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Entity Type | Individual
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Provider Name | JESSIE MAURER
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Gender | Female
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 1375 R DALE WERTZ DR
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City | BAD AXE
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State | MI
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Zip | 48413-1365
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Country | US
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Telephone | 989-269-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 5080 RUTH RD
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City | RUTH
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State | MI
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Zip | 48470-9732
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Country | US
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Telephone | 810-837-2031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704301080
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License Number State | MI
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