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General NPI Number Information
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NPI Number | 1184423006
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Entity Type | Individual
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Provider Name | JESSICA RAE NASSER
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Gender | Female
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 798 W MILE RD NW
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City | KALKASKA
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State | MI
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Zip | 49646-8431
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Country | US
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Telephone | 231-348-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 9677 HOLLY AVE
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City | GRAYLING
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State | MI
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Zip | 49738-7415
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Country | US
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Telephone | 989-701-0970
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501009882
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License Number State | MI
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