Healthcare Provider Details

I. General information

NPI: 1881032605
Provider Name (Legal Business Name): JULIE LYNN PRYOR R.N./BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E MICHIGAN AVE STE 101
JACKSON MI
49202-3765
US

IV. Provider business mailing address

2301 E MICHIGAN AVE STE 101
JACKSON MI
49202-3765
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-3434
  • Fax: 517-782-6446
Mailing address:
  • Phone: 517-783-3434
  • Fax: 517-782-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704207739
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704207739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: