Provider Demographics
NPI:1609459023
Name:SCHAEFER, JESSICA MARGARET
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARGARET
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARGARET
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3356 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3335
Mailing Address - Country:US
Mailing Address - Phone:989-714-0454
Mailing Address - Fax:
Practice Address - Street 1:3356 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3335
Practice Address - Country:US
Practice Address - Phone:989-714-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program