STEPHANIE MICHELLE JACKS (NPI# 1336702562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336702562 |
| Entity Type | Individual |
| Full Name | STEPHANIE MICHELLE JACKS |
| Practice Address |
1701 South Blvd E Ste 190 Rochester Hills MI 48307-6124 |
| Mailing Address |
46355 Rockford Dr Shelby Twp MI 48315-5626 |
| Practice Telephone | 5865800760 |
| Mailing Telephone | 5864194856 |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2020-01-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 4704313742 | MI | Nursing Service Providers |
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
4704313742 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952783912 | Stephanie Dawn Jacks | Nurse Practitioner | 5153 N 9th Ave Ste 201, Pensacola, FL 32504 | 2015-06-25 |
| 1003041567 | Stephanie Jacks | Dermatology | 6701 Fannin St, Houston, TX 77030-2608 | 2009-05-27 |
| Street Address |
1701 SOUTH BLVD E STE 190 |
| City | ROCHESTER HILLS |
| State | MI |
| Zip Code | 48307-6124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841245263 | Farah Rafik Dawood-farah | Internal Medicine | 1701 South Blvd E Ste 190, Rochester Hills, MI 48307-6124 | 2006-05-24 |
| 1073994158 | Joel Szela | Internal Medicine | 1701 South Blvd E Ste 190, Rochester Hills, MI 48307-6124 | 2015-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083238851 | Martin Dukaj | Student in an Organized Health Care Education/Training Program | 1101 Walton Blvd, Rochester Hills, MI 48307 | 2020-06-08 |
| 1073151973 | Cynthia Lynn Olekszyk | Dietitian, Registered | 645 Barclay Circle, Rochester Hills, MI 48307 | 2019-12-11 |
| 1326502428 | Jessica Delia | Nurse Practitioner | 1701 E South Boulevard, Suite 290, Rochester Hills, MI 48307 | 2019-01-23 |
| 1528530037 | Kelie Friday | Physical Therapist | 312 Rochester Hills, Dearborn, MI 48307 | 2018-12-21 |
| 1538635883 | Julie Latarewicz | Physical Therapist | Ascension Providence Rochester Hospital, 1101 West University Drive, Rochester, MI 48307 | 2018-10-15 |
| 1891270757 | Leah Marx | Social Worker | 3950 Rochester Rd, Ste 2250, Rochester Hills, MI 48307 | 2018-09-26 |
| 1598256729 | Frederick Alan Bittner | Student in an Organized Health Care Education/Training Program | 1101 W. University Drive, 3 North, Rochester, MI 48307 | 2018-05-23 |
| 1508356346 | Ankita Aggarwal | Student in an Organized Health Care Education/Training Program | Wsu/ascension Crittenton Hospital, 1101 W. University Drive, Rochester, MI 48307 | 2018-05-17 |
| 1619478195 | Michelle Nuccio | Occupational Therapist | 1555 E South Blvd, Rochester Hills, MI 48307 | 2018-02-21 |
| 1265932024 | Stacy Dietlin Linn | Physical Therapist | 1555 E. South Blvd, Suite 120, Rochester Hills, MI 48307 | 2018-02-19 |
| Find all providers in zip 48307 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720584899 | Nichole Leshawn Fuller | Nurse Practitioner | 1428 Leupp Ct, Rochester Hills, MI 48307-3021 | 2018-04-05 |
| 1609274620 | Pei-hsuan Wu | Nurse Practitioner | 572 Tennyson, Rochester Hills, MI 48307-4245 | 2014-12-08 |
| 1508104456 | Mary Elizabeth Kocenda | Nurse Practitioner | 95 Stark Rd, Rochester Hills, MI 48307-3866 | 2013-01-28 |
| 1245386275 | Ellen M Melcher | Nurse Practitioner | 2494 S Rochester Rd, Rochester Hills, MI 48307-3817 | 2007-01-25 |
| 1922380989 | Tricia Lynn Fabbri | Nurse Practitioner | 1101 W University Dr, Rochester Hills, MI 48307-1863 | 2011-09-15 |
| 1457507287 | Mary E Thibert | Nurse Practitioner | 1886 W Auburn Rd, Suite 400, Rochester Hills, MI 48309-3865 | 2008-08-12 |
| 1689630568 | Rochester Urology PC | Nurse Practitioner | 1202 Walton Blvd, Suite 211, Rochester Hills, MI 48307-6900 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437759396 | Zainab Ali Hachem | Nurse Practitioner | 5158 Neckel St, Dearborn, MI 48126-3217 | 2020-10-29 |
| 1861092900 | Lindsay Overall | Nurse Practitioner | 1962 Sherlynn Dr, Brighton, MI 48114-7618 | 2020-10-28 |
| 1588289144 | Anne Elizabeth Stephan | Nurse Practitioner | 1320 Addington Ln, Ann Arbor, MI 48108-8951 | 2020-06-10 |
| 1447872965 | Gagan Preet Kaur Dhaliwal | Nurse Practitioner | 45418 Glengarry Blvd, Canton, MI 48188-3001 | 2020-05-07 |
| 1023637766 | Jbnp Services, LLC | Nurse Practitioner | 19520 Parker St, Livonia, MI 48152-1579 | 2020-04-13 |
| 1912536137 | Mary Bailey | Nurse Practitioner | 8254 Twin Creek Cir, Temperance, MI 48182-8202 | 2020-04-08 |
| 1679108500 | Jennifer Ann Rutzen | Nurse Practitioner | 5802 Montebello Ave, Haslett, MI 48840-8208 | 2020-03-11 |
| 1871126813 | Gregory M Ali | Nurse Practitioner | 26750 Providence Pkwy Ste 120, Novi, MI 48374-1211 | 2020-02-18 |
| 1730712969 | Anthony Joseph Jurecic | Nurse Practitioner | 2382 Us 41 W, Marquette, MI 49855-2456 | 2020-02-17 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| Find all providers with the same taxonomy | ||||
| City | ROCHESTER HILLS |
| Zip Code | 48307 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.