=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699198119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNE M TREMBLEY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2014
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 E SHERMAN BLVD
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49444-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-672-3500
-----------------------------------------------------
Fax | 231-672-6199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10558 KNOLLGATE DR # DT
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49423-9290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-403-0444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 5601006920
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------