Provider Demographics
NPI:1184811499
Name:THERING, JACQUELYN D
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:D
Last Name:THERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:D
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:501 LAPEER
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1208
Practice Address - Country:US
Practice Address - Phone:989-759-6464
Practice Address - Fax:989-399-8233
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381908328-380 DRGOtherCCM/CARE SOURCE
MI1027818 DRGOtherHEALTHADVANTAGE
MI381908328408BRIDGEPOOtherCCM/CARESOURCE
MI381908328411 OUTEROtherCCM/CARE SOURCE
MI381908328-407 BAYSIDOtherCCM/CARE SOURCE
MI1027818 DRGOtherMCLAREN HEALTH PLAN
MI381908328413 ST.VINOtherCCM/CARE SOURCE
MI4686650OtherMOLINA HEALTHCARE
MI164342OtherGREAT LAKES HEALTH PLAN
MI381908328409 JANESOtherCCM/CARE SOURCE
MI381908328412 COMMEROtherCCM/CARE SOURCE
MI381908328410RUFFINOtherCCM/CARE SOURCE
MI1027818 DRGOtherHEALTHADVANTAGE