Individual
JOLENE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
760 W FRANKLIN ST, JACKSON, MI 49201-2048
(517) 780-9260
(517) 780-9263
Mailing address
760 W FRANKLIN ST, JACKSON, MI 49201-2048
(517) 780-9260
(517) 780-9263
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301058029
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4649460
—
MI
Enumeration date
04/13/2006
Last updated
03/03/2020
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