Individual
DANIELLE NEESAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 PAGE AVE, JACKSON, MI 49201-2419
(517) 205-1234
(517) 205-1050
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009884
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601009884
MICHIGAN PHYSICIAN ASSISTANT LICENSE
MI
Enumeration date
07/20/2020
Last updated
10/09/2025
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