Individual
JACKIE R GYOMORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-5000
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN586505
PA
363LA2100X
Acute Care Nurse Practitioner
209.010429
IL
363LA2100X
Acute Care Nurse Practitioner
Primary
4704259474
MI
Other
Enumeration date
11/01/2010
Last updated
07/29/2022
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