Individual
MATTHEW MICHAEL JACQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
303 E KEARSLEY ST, FLINT, MI 48502-1907
(810) 762-3000
Mailing address
5525 MILLINGTON RD, MILLINGTON, MI 48746-9538
(810) 210-9502
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704295616
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/31/2020
Last updated
10/04/2022
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