Healthcare Provider Details

I. General information

NPI: 1144621459
Provider Name (Legal Business Name): JESSICA CIARAMELLA DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2014
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39425 GARFIELD RD STE 24
CLINTON TOWNSHIP MI
48038-4651
US

IV. Provider business mailing address

39425 GARFIELD RD STE 24
CLINTON TOWNSHIP MI
48038-4651
US

V. Phone/Fax

Practice location:
  • Phone: 810-650-8909
  • Fax:
Mailing address:
  • Phone: 810-650-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704287559
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704287559
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704287559
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: