Individual
MRS. JESSICA L UMLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6100 NEWPORT RD, SUITE 100, PORTAGE, MI 49002-9235
(269) 343-4679
(269) 343-5929
Mailing address
6100 NEWPORT RD, SUITE 100, PORTAGE, MI 49002-9235
(269) 343-4679
(269) 343-5929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
56010-04622
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C96019007
MEDICARE / PTAN
—
Enumeration date
12/12/2006
Last updated
12/12/2012
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