Provider Demographics
NPI:1255844452
Name:COLBERG, JESSICA (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:COLBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:990 W ANN ARBOR TRL STE 210
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6202
Practice Address - Country:US
Practice Address - Phone:734-455-4600
Practice Address - Fax:734-455-5637
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290365163W00000X, 363LP0200X
MI20173296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No208000000XAllopathic & Osteopathic PhysiciansPediatrics