=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811952781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA M PAQUETTE DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 07/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 718 N SAINT JOSEPH ST UNIT K1
-----------------------------------------------------
City | SUTTONS BAY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49682-8422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-386-0088
-----------------------------------------------------
Fax | 855-537-4321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 718 N SAINT JOSEPH ST UNIT K1
-----------------------------------------------------
City | SUTTONS BAY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49682-8422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-386-0088
-----------------------------------------------------
Fax | 855-537-4321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101015389
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------