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General NPI Number Information
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NPI Number | 1447216999
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Entity Type | Individual
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Provider Name | JILL ANNE LEBOURDAIS PA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 4905 BERL DR
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City | SAGINAW
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State | MI
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Zip | 48604-2801
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Country | US
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Telephone | 989-996-0566
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Fax | 989-583-6915
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Provider Business Mailing Address
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Address Line | 3785 BAY RD
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City | SAGINAW
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State | MI
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Zip | 48603-2433
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601003221
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License Number State | MI
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