Healthcare Provider Details

I. General information

NPI: 1205359106
Provider Name (Legal Business Name): ALEXANDREA JADE GARBUS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 CASS AVE
DETROIT MI
48201-1709
US

IV. Provider business mailing address

2260 ELLWOOD AVE
BERKLEY MI
48072-3204
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-7776
  • Fax: 734-926-8987
Mailing address:
  • Phone: 313-330-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM04202
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: