Individual
JACOB DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 985-8900
Mailing address
4036 HILL DR APT 202, SHELBY TOWNSHIP, MI 48317-4810
(810) 357-5968
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704387820
MI
Other
Enumeration date
09/02/2025
Last updated
09/02/2025
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