Provider Demographics
NPI:1326474248
Name:ONUFRAK, JESSICA ANN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:ONUFRAK
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:PIKURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3350 GRATIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2121
Mailing Address - Country:US
Mailing Address - Phone:810-364-4000
Mailing Address - Fax:810-364-5995
Practice Address - Street 1:3350 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2121
Practice Address - Country:US
Practice Address - Phone:810-364-4000
Practice Address - Fax:810-364-5995
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704266390363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326474248Medicaid