Individual
JACLYN RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2050 N HAGGERTY RD STE 200, CANTON, MI 48187-3796
(313) 550-3353
Mailing address
1083 BEACONSFIELD AVE, GROSSE POINTE PARK, MI 48230-1346
(313) 550-3353
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704347010
MI
Other
Enumeration date
01/09/2021
Last updated
09/29/2023
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