Individual
MS. JACQUELYN LAUREN EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(800) 436-7936
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2689
(800) 678-1861
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006985
MI
Other
Enumeration date
06/14/2014
Last updated
09/19/2024
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