Healthcare Provider Details

I. General information

NPI: 1619334489
Provider Name (Legal Business Name): PATRICIA ANN ANKNEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

505 N JACKSON ST
JACKSON MI
49201-1266
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-4361
  • Fax: 517-787-4983
Mailing address:
  • Phone: 517-787-4361
  • Fax: 517-787-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902003722
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: