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General NPI Number Information
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NPI Number | 1013574086
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Entity Type | Individual
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Provider Name | JENNA RAYIS M.S., PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1017 ORCHARD GROVE DR
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City | ROYAL OAK
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State | MI
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Zip | 48067-4331
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Country | US
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Telephone | 248-836-8764
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Fax |
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Provider Business Mailing Address
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Address Line | 4636 WOODLAND HILLS DR
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City | ROCHESTER
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State | MI
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Zip | 48306-1771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601009188
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License Number State | MI
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