Individual
JACLYN L GINGRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
44201 DEQUINDRE RD, TROY, MI 48085-1117
(248) 964-5000
(248) 964-4848
Mailing address
130 TOWN CENTER DR STE 203, TROY, MI 48084-1744
(248) 585-8218
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704295937
MI
363LF0000X
Family Nurse Practitioner
4704295937
MI
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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