Healthcare Provider Details

I. General information

NPI: 1477987188
Provider Name (Legal Business Name): ALMETA M ANDARY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALMETA MYRTICE JACKSON MSN, RN, FNP-C

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 GRATIOT AVE SUITE C
DETROIT MI
48213-1363
US

IV. Provider business mailing address

22341 WEST EIGHT MILE RD SUITE #4
DETROIT MI
48219
US

V. Phone/Fax

Practice location:
  • Phone: 313-372-7111
  • Fax: 313-372-5509
Mailing address:
  • Phone: 313-421-6643
  • Fax: 313-372-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704261320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: