Individual
JESSICA AC JUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
800 EAST BLVD, KINGSFORD, MI 49802-4436
(906) 774-4000
(906) 774-0088
Mailing address
PO BOX 220, MARQUETTE, MI 49855-0220
(906) 225-4821
(906) 225-4537
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704220408
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4705237
—
MI
01
—
5008750240
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
12/01/2005
Last updated
02/25/2008
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