Individual
JESSECA ANTHONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
2688 PEACHCREST ST, YPSILANTI, MI 48198-3323
(734) 329-1859
Mailing address
1342 STACY DR, CANTON, MI 48188-1439
(734) 329-1859
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703112763
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114014529
—
MI
Enumeration date
06/06/2017
Last updated
06/06/2017
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