Provider Demographics
NPI:1811935794
Name:JURCICH, PATRICIA M (RN,MSN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:JURCICH
Suffix:
Gender:F
Credentials:RN,MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BEVIER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-1209
Mailing Address - Country:US
Mailing Address - Phone:231-861-2187
Mailing Address - Fax:231-861-5100
Practice Address - Street 1:71 BEVIER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1209
Practice Address - Country:US
Practice Address - Phone:231-861-2187
Practice Address - Fax:231-861-5100
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704168095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704168095OtherSTATE LICENSE
MIMI7481007Medicare PIN