Provider Demographics
NPI:1407520471
Name:JAQUES, ERIN MARGARGET (RN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARGARGET
Last Name:JAQUES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARGARET
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15731 N DR N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9425
Mailing Address - Country:US
Mailing Address - Phone:269-209-6865
Mailing Address - Fax:
Practice Address - Street 1:290 B DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-8427
Practice Address - Country:US
Practice Address - Phone:269-888-6503
Practice Address - Fax:269-888-6503
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240608163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management