Individual
JILL CHRISTINE SIDANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
118 ELIZABETH WAY # 4, POTTERVILLE, MI 48876-9545
(517) 505-2749
Mailing address
118 ELIZABETH WAY # 4, POTTERVILLE, MI 48876-9545
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704265752
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704265752
N P SPECIALTY CERTIFICATE
MI
Enumeration date
11/14/2014
Last updated
05/26/2021
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