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Individual

JENNIFER MODINA ROQUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
22101 MOROSS, DETROIT, MI 48236
(313) 343-4370
Mailing address
34841 FONTANA DRIVE, STERLING HEIGHTS, MI 48312

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704231669
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704231669
MI

Other

Enumeration date
09/02/2018
Last updated
10/12/2018
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