Individual
JESSICA ELEANOR HERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1391 E PARKDALE AVE, MANISTEE, MI 49660-9352
(231) 398-1760
(231) 398-1768
Mailing address
1391 E PARKDALE AVE, MANISTEE, MI 49660-9352
(231) 398-1760
(231) 398-1768
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008552
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601008552
MICHIGAN LICENSE
MI
Enumeration date
02/01/2018
Last updated
07/01/2021
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