Healthcare Provider Details

I. General information

NPI: 1548195191
Provider Name (Legal Business Name): JOLIETTE BROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5186 COUNTY ROAD 360
DAGGETT MI
49821-8821
US

IV. Provider business mailing address

W5186 COUNTY ROAD 360
DAGGETT MI
49821-8821
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-3311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number4704344453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: