Individual ProviderJacob JewellNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address20952 E 12 Mile Rd Ste 200, Saint Clair Shores, MI 48081-3203(586) 771-4820PECOS EnrollmentBased on the most recent information from CMS, provider Jacob Jewell is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1902419104Provider TypeIndividualFull NameJewell, JacobCredentialFNP-CGenderMaleSole ProprietorYesEnumeration Date8/26/2020Last Updated9/22/2020Contact InformationPractice LocationPractice Address20952 E 12 Mile Rd Ste 200, Saint Clair Shores, MI 48081-3203Phone(586) 771-4820Fax(586) 771-6620Mailing LocationMailing Address20952 E 12 Mile Rd Ste 200, Saint Clair Shores, MI 48081-3203Phone(586) 771-4820Fax(586) 771-6620Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense4704301664Michigan