Provider Demographics
NPI:1386077980
Name:DESCHAMPS, TRISHA JANE (FNP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:JANE
Last Name:DESCHAMPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49746-0427
Mailing Address - Country:US
Mailing Address - Phone:989-742-4583
Mailing Address - Fax:989-742-2183
Practice Address - Street 1:15774 STATE ST
Practice Address - Street 2:
Practice Address - City:HILLMAN
Practice Address - State:MI
Practice Address - Zip Code:49746-7961
Practice Address - Country:US
Practice Address - Phone:989-742-4583
Practice Address - Fax:989-742-2183
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF06016081Medicare Oscar/Certification