Provider Demographics
NPI:1952591570
Name:JASKIEWICZ, MICHAEL GABRIELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MICHAEL
Middle Name:GABRIELLE
Last Name:JASKIEWICZ
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:50 INDUSTRIAL PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:870 COLFAX AVENUE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022
Practice Address - Country:US
Practice Address - Phone:855-869-6900
Practice Address - Fax:269-925-6370
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN4704258888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily