Healthcare Provider Details

I. General information

NPI: 1811718331
Provider Name (Legal Business Name): CELINE JARBO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42350 GRAND RIVER AVE
NOVI MI
48375-1838
US

IV. Provider business mailing address

42350 GRAND RIVER AVE
NOVI MI
48375-1838
US

V. Phone/Fax

Practice location:
  • Phone: 248-697-2942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704364890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: