Healthcare Provider Details

I. General information

NPI: 1225181589
Provider Name (Legal Business Name): JILL KAYE LOTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HANCOCK ST
SAGINAW MI
48602-4224
US

IV. Provider business mailing address

304 S NIAGARA ST
SAGINAW MI
48602-1570
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-3400
  • Fax: 989-799-3918
Mailing address:
  • Phone: 989-799-6542
  • Fax: 989-799-6681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704200154
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: