Individual
JESSICA WENTWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
26850 PROVIDENCE PKWY, NOVI, MI 48374-1213
(248) 465-5330
Mailing address
26850 PROVIDENCE PKWY, NOVI, MI 48374-1213
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4704282917
MI
Other
Enumeration date
07/07/2016
Last updated
03/17/2018
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