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Individual

JACLYN CAROL HOUSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, FNP-BC, RN

Contact information

Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-2879
Mailing address
13117 W 11 MILE RD, HUNTINGTON WOODS, MI 48070-1009
(248) 259-3075

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704276550
MI
363LF0000X
Family Nurse Practitioner
Primary
4704276550
MI

Other

Enumeration date
10/08/2014
Last updated
01/08/2015
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