Provider Demographics
NPI:1730771700
Name:TRUMPH, JESSICA RIO-MARIE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RIO-MARIE
Last Name:TRUMPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SOUTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3540
Mailing Address - Country:US
Mailing Address - Phone:248-778-8813
Mailing Address - Fax:
Practice Address - Street 1:1943 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1519
Practice Address - Country:US
Practice Address - Phone:810-985-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF10230868363L00000X
MI4704319270163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse