Provider Demographics
NPI:1942738117
Name:JUCKNO, EMILY JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:JUCKNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 FRANKFORT
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8432
Mailing Address - Country:US
Mailing Address - Phone:734-474-6447
Mailing Address - Fax:
Practice Address - Street 1:10707 FRANKFORT
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8432
Practice Address - Country:US
Practice Address - Phone:734-474-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant