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General NPI Number Information
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NPI Number | 1225743909
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Entity Type | Organization
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Legal Business Name | JJDM MANAGEMENT OF MARQUETTE
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 712 CHIPPEWA SQ STE 100
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City | MARQUETTE
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State | MI
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Zip | 49855-4825
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Country | US
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Telephone | 906-205-4425
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Fax |
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Provider Business Mailing Address
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Address Line | 771 BLEMHUBER AVE
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City | MARQUETTE
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State | MI
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Zip | 49855-4828
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Country | US
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Telephone | 906-250-5051
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MICHELE LEE PREMEAU
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Credential | NP
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Telephone | 906-250-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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