Healthcare Provider Details

I. General information

NPI: 1730530619
Provider Name (Legal Business Name): JASON MCCREE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 LINCOLN ST
DEARBORN MI
48124-3509
US

IV. Provider business mailing address

3521 LINCOLN ST
DEARBORN MI
48124-3509
US

V. Phone/Fax

Practice location:
  • Phone: 248-291-4281
  • Fax:
Mailing address:
  • Phone: 248-291-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704180803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: