Healthcare Provider Details

I. General information

NPI: 1639534373
Provider Name (Legal Business Name): JACQUELYN ELLEN MELDRUM RN, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15506 S TELEGRAPH RD
MONROE MI
48161-5520
US

IV. Provider business mailing address

15506 S TELEGRAPH RD
MONROE MI
48161-5520
US

V. Phone/Fax

Practice location:
  • Phone: 520-404-6696
  • Fax:
Mailing address:
  • Phone: 419-724-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3948816
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: