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Individual

JORDAN WYETH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
220 W GARFIELD AVE, CHARLEVOIX, MI 49720-1631
(231) 547-6523
Mailing address
3816 LORRAINE DR, PETOSKEY, MI 49770-8640
(989) 233-4085

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704305091
MI

Other

Enumeration date
05/03/2021
Last updated
05/03/2021
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