Individual
MRS. JESSICA JUNE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, MSN, NP
Contact information
Practice address
12895 DENNISON RD, MILAN, MI 48160-9594
(734) 752-7693
Mailing address
18103 CEDAR ISLAND BLVD, BROWNSTOWN, MI 48174-9583
(734) 752-7693
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704253687
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704253687
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578890323
—
MI
Enumeration date
11/13/2009
Last updated
11/07/2022
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