Individual
JAZMINE S RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9608 PINEHURST ST, DETROIT, MI 48204-4652
(313) 421-9771
Mailing address
9608 PINEHURST ST, DETROIT, MI 48204-4652
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704327595
MI
363LG0600X
Gerontology Nurse Practitioner
4704327595
MI
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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