Provider Demographics
NPI:1497828214
Name:TURMELL, JACOB WILLIAM (NP-C)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:WILLIAM
Last Name:TURMELL
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:MR
Other - First Name:JACOB
Other - Middle Name:WILLIAM
Other - Last Name:AINSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2774 BIRCHCREST DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5477
Mailing Address - Country:US
Mailing Address - Phone:616-309-7250
Mailing Address - Fax:
Practice Address - Street 1:2774 BIRCHCREST DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-309-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229938363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4951606Medicaid
MIN54580011Medicare PIN