Individual
JEAN GASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
4669 RAVINE DR, BLOOMFIELD TOWNSHIP, MI 48301
(248) 594-7442
Mailing address
4669 RAVINE DR, BLOOMFIELD TOWNSHIP, MI 48301-3640
(248) 594-7442
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704099640
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JG099640
BCBSM
MI
Enumeration date
02/07/2007
Last updated
05/24/2018
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