Provider Demographics
NPI:1043564305
Name:ALIGHIRE, JESSICA RAE
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RAE
Last Name:ALIGHIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 CASCADE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-957-3500
Mailing Address - Fax:616-957-3501
Practice Address - Street 1:4081 CASCADE RD SE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2170
Practice Address - Country:US
Practice Address - Phone:616-957-3500
Practice Address - Fax:616-957-3501
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363AM0700X
MI5601006547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical