=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619079233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN LAFEVER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2006
-----------------------------------------------------
Last Update Date | 12/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 NAOMI ST
-----------------------------------------------------
City | PLAINWELL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49080-1257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-552-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 W PATERSON ST
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49007-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-349-2641
-----------------------------------------------------
Fax | 269-201-2855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5601002054
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------