Individual
COURTNEY MARIE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
10648 GRANGE AVE NE, ROCKFORD, MI 49341-9131
(616) 334-8124
Mailing address
10648 GRANGE AVE NE, ROCKFORD, MI 49341-9131
(616) 334-8124
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704418051
MI
Other
Enumeration date
07/05/2024
Last updated
07/05/2024
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