Individual
JESSYKA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3176 CANTON ST, DETROIT, MI 48207-2542
(313) 633-3082
Mailing address
3176 CANTON ST, DETROIT, MI 48207-2542
(313) 633-3082
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
T520403734328
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
750577870
—
MI
Enumeration date
12/04/2015
Last updated
12/04/2015
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