Healthcare Provider Details

I. General information

NPI: 1447171715
Provider Name (Legal Business Name): JENNIFER ELAINE RANKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19611 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-1655
US

IV. Provider business mailing address

22487 BOULDER AVE
EASTPOINTE MI
48021-2305
US

V. Phone/Fax

Practice location:
  • Phone: 586-455-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: