Individual
JENNIFER R IDRISSU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3455 STARR RD, ROYAL OAK, MI 48073-2100
(248) 288-9340
(248) 965-3029
Mailing address
5280 METROPOLITAN PKWY, STERLING HEIGHTS, MI 48310-4005
(248) 290-3111
(248) 290-3100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704245483
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704245483
MI
Other
Enumeration date
04/22/2020
Last updated
06/18/2024
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