Provider Demographics
NPI:1821832460
Name:JURETICH, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:JURETICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5752 ELDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-2627
Mailing Address - Country:US
Mailing Address - Phone:586-995-2728
Mailing Address - Fax:
Practice Address - Street 1:5752 ELDRIDGE DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-2627
Practice Address - Country:US
Practice Address - Phone:586-995-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant