Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jessica R Mandziara

Individual provider Nurse Practitioner · NPI 1386303196

Jessica R Mandziara is a Nurse Practitioner in Ferndale, Michigan. Qualified in 2021, 5 years ago. Practices with Kootenai Health Inc, a 394-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho and Michigan.

Years since qualifying
5
Licensed in
ID, MI
In the registry since
2021
Specialties on file
2

Practice location Address checks out

466 Pearson St
Ferndale, MI 48220-3308
Phone: (734) 752-3476
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 — (208) 625-6900

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 4704321864 (MI)
Nurse Practitioner Taxonomy 363L00000X · Licence 72242 (ID)

Record details

NPI number1386303196
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 9, 2021
Last updated in NPPESJuly 24, 2025
Certification dateJuly 24, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Kootenai Health Inc — 394 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Ferndale