Individual
JACQUELYN NICOLE PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
301 W WACKERLY ST, MIDLAND, MI 48640-2761
(989) 832-0900
(989) 633-0349
Mailing address
301 W WACKERLY ST, MIDLAND, MI 48640-2761
(989) 832-0900
(989) 633-0349
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007908
MI
Other
Enumeration date
09/12/2016
Last updated
01/22/2019
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