Provider Demographics
NPI:1447923925
Name:FEHRENBACH, JESSICA RAE (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:FEHRENBACH
Suffix:
Gender:F
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BELLEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2238
Mailing Address - Country:US
Mailing Address - Phone:586-676-8427
Mailing Address - Fax:586-314-0707
Practice Address - Street 1:45 BELLEVIEW ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2238
Practice Address - Country:US
Practice Address - Phone:586-676-8427
Practice Address - Fax:586-314-0707
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty