Individual
JILL SUSAN MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNC
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7705
(734) 785-7734
Mailing address
25528 KNAPP LN, BROWNSTOWN, MI 48134-0715
(734) 789-9914
(313) 389-2956
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
4704168922
MI
Other
Enumeration date
06/05/2007
Last updated
07/23/2007
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