Individual
JESSICA FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-3456
Mailing address
6004 RELIABLE PARKWAY LOCKBOX CHI 866004, CHICAGO, IL 60686-0060
(734) 263-2400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2293762
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
4704308220
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669979670
—
MI
Enumeration date
04/07/2018
Last updated
10/02/2019
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