Individual
JENNIFER SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
309 PAGE AVE, JACKSON, MI 49201-2419
(517) 205-1234
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 876-4806
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704354239
MI
363LG0600X
Gerontology Nurse Practitioner
4704354239
MI
Other
Enumeration date
07/10/2023
Last updated
11/14/2023
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