Individual
JESSICA WOODMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(248) 807-6436
Mailing address
43 BROOKWOOD LN, PONTIAC, MI 48340-1404
(248) 807-6436
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703121941
MI
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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