Individual
ELIZABETH AMABO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 GREENWOOD AVE, JACKSON, MI 49203-4047
(517) 787-5710
Mailing address
1515 GREENWOOD AVE, JACKSON, MI 49203-4047
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703109243
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
922184963
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/09/2016
Last updated
03/09/2016
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