=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891178166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA ANN STARIHA RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2015
-----------------------------------------------------
Last Update Date | 07/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 376 E APPLE AVE
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49442-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-724-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2966 RENNELLS RD
-----------------------------------------------------
City | SPRING LAKE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49456-9671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-557-3248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 4704287564
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------