Individual
JESSICA LYNN KATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
19229 MACK AVE STE 28, GROSSE POINTE WOODS, MI 48236-2857
(313) 647-3200
Mailing address
28235 DELTON ST, MADISON HEIGHTS, MI 48071-2822
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704256354
MI
Other
Enumeration date
01/23/2019
Last updated
09/30/2021
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