Provider Demographics
NPI:1598160079
Name:CHUBB, JESSICA KATHERINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHERINE
Last Name:CHUBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KATHERINE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:384 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1745
Mailing Address - Country:US
Mailing Address - Phone:989-820-4859
Mailing Address - Fax:
Practice Address - Street 1:384 2ND ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1745
Practice Address - Country:US
Practice Address - Phone:989-820-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse