Individual
JILLIAN N PETKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
72 S WASHINGTON ST, OXFORD, MI 48371-6421
(248) 236-8333
(248) 236-8666
Mailing address
215 E AUBURN RD, ROCHESTER HILLS, MI 48307-5260
(248) 853-2009
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704266490
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700036936
—
MI
Enumeration date
07/30/2012
Last updated
08/06/2014
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