Healthcare Provider Details

I. General information

NPI: 1013795210
Provider Name (Legal Business Name): JAYNE A DEBOER-ROWSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

1831 BRIARWOOD DR
MADISON HEIGHTS MI
48071-2276
US

V. Phone/Fax

Practice location:
  • Phone: 248-830-9510
  • Fax:
Mailing address:
  • Phone: 313-878-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704251702
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704251702
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704251702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: