Individual
JUDY L JEROME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CGNP
Contact information
Practice address
829 N CENTER AVE, SUITE 140, GAYLORD, MI 49735-1595
(989) 731-7870
(989) 731-7837
Mailing address
310 N. MAIN STREET, SUITE 301, CHELSEA, MI 48118-1807
(734) 222-8200
(734) 222-8202
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4704120506
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
381303843
TAX ID
—
01
—
4704120506
MICHIGAN STATE LICENSE
MI
05
—
4874937
—
MI
Enumeration date
05/15/2006
Last updated
03/07/2023
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