Individual
MS. JESSICA PONTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
25631 LITTLE MACK AVE STE 205, SAINT CLAIR SHORES, MI 48081-2108
(586) 443-2930
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704308762
MI
363LG0600X
Gerontology Nurse Practitioner
4704308762
MI
Other
Enumeration date
04/19/2021
Last updated
01/06/2025
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