Healthcare Provider Details

I. General information

NPI: 1487989455
Provider Name (Legal Business Name): JEFFREY CLAY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S INDUSTRIAL HWY SUITE 75
ANN ARBOR MI
48104-6796
US

IV. Provider business mailing address

2850 S INDUSTRIAL HWY SUITE 75
ANN ARBOR MI
48104-6796
US

V. Phone/Fax

Practice location:
  • Phone: 734-477-7298
  • Fax: 734-998-2369
Mailing address:
  • Phone: 734-477-7298
  • Fax: 734-998-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704219290
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: