Individual
JENNIFER WIMS-MADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, PMHNP-BC
Contact information
Practice address
1685 BALDWIN AVE, PONTIAC, MI 48340-1115
(248) 999-9999
Mailing address
1685 BALDWIN AVE, PONTIAC, MI 48340-1115
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704259811
MI
163WP0808X
Psychiatric/Mental Health Registered Nurse
4704259811
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704259811
MI
Other
Enumeration date
07/19/2012
Last updated
12/05/2022
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