Individual
JULIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4640 MILL POND DR, TROY, MI 48085-3782
(615) 415-7522
Mailing address
4640 MILL POND DR, TROY, MI 48085-3782
(615) 415-7522
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704328543
MI
Other
Enumeration date
10/29/2021
Last updated
10/29/2021
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