Individual
MARY ROOF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4800
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704335747NSA2404U
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704335747
MI
Other
Enumeration date
07/02/2024
Last updated
10/17/2024
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