Provider Demographics
NPI:1689173023
Name:HAMEL, JESSICA DIANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANE
Last Name:HAMEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1520
Mailing Address - Country:US
Mailing Address - Phone:517-525-1466
Mailing Address - Fax:
Practice Address - Street 1:2390 WOODLAKE DR STE 380
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6018
Practice Address - Country:US
Practice Address - Phone:517-333-7113
Practice Address - Fax:517-333-7125
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily