Provider Demographics
NPI:1225743909
Name:JJDM MANAGEMENT OF MARQUETTE
Entity Type:Organization
Organization Name:JJDM MANAGEMENT OF MARQUETTE
Other - Org Name:PRIMO HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PREMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:906-250-5051
Mailing Address - Street 1:771 BLEMHUBER AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4828
Mailing Address - Country:US
Mailing Address - Phone:906-250-5051
Mailing Address - Fax:
Practice Address - Street 1:712 CHIPPEWA SQ STE 100
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4825
Practice Address - Country:US
Practice Address - Phone:906-205-4425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty