Healthcare Provider Details

I. General information

NPI: 1477095594
Provider Name (Legal Business Name): JONI FROST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 SPRING ARBOR RD
JACKSON MI
49203-3655
US

IV. Provider business mailing address

2585 SPRING ARBOR RD
JACKSON MI
49203-3655
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1285
  • Fax: 517-205-0115
Mailing address:
  • Phone: 517-205-1285
  • Fax: 517-205-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704284987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: