Healthcare Provider Details

I. General information

NPI: 1831289388
Provider Name (Legal Business Name): JEANNE MARIE PYONK ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27351 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3487
US

IV. Provider business mailing address

33005 HAMPSHIRE ST
WESTLAND MI
48185-9617
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-7585
  • Fax:
Mailing address:
  • Phone: 734-237-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704184391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: