Individual
MRS. JESSICA E PAONESSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1221 SIXTH ST STE 100, TRAVERSE CITY, MI 49684
(231) 935-0322
(231) 935-0334
Mailing address
1221 SIXTH ST STE 100, TRAVERSE CITY, MI 49684-2359
(231) 935-0322
(231) 935-0334
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01071233A
IN
208800000X
Urology Physician
274692
NY
208800000X
Urology Physician
Primary
4301113807
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000792827
ANTHEM PIN
IN
05
—
03884526
—
NY
05
—
201112070
—
IN
Enumeration date
03/22/2007
Last updated
09/13/2021
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