Individual
JACQUELYN FREEMAN-INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17475 LOWELL ST, ROSEVILLE, MI 48066-2818
(313) 510-1275
Mailing address
17475 LOWELL ST, ROSEVILLE, MI 48066-2818
(313) 510-1275
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703062635
MI
Other
Enumeration date
07/18/2016
Last updated
07/18/2016
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