Basic Information
| Provider Information | |||||||||
| NPI: | 1811935794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JURCICH | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN,MSN,FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 BEVIER ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494551209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318612187 | ||||||||
| FaxNumber: | 2318615100 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 BEVIER ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494551209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318612187 | ||||||||
| FaxNumber: | 2318615100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704168095 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4704168095 | 01 | MI | STATE LICENSE | OTHER |