Individual
MRS. JACKIE WALGRAM
Active
Individual
MRS. JACKIE WALGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN/HEALTH EDUCATOR
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
4704132716
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704132716
LICENSE
MI
Enumeration date
08/15/2008
Last updated
08/14/2019
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