Healthcare Provider Details

I. General information

NPI: 1730793241
Provider Name (Legal Business Name): JEANETTE A BACCI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30600 TELEGRAPH RD STE 4000
BINGHAM FARMS MI
48025-5726
US

IV. Provider business mailing address

30600 TELEGRAPH RD
BINGHAM FARMS MI
48025-4530
US

V. Phone/Fax

Practice location:
  • Phone: 248-593-0100
  • Fax:
Mailing address:
  • Phone: 248-593-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704318901
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: