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General NPI Number Information
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NPI Number | 1033713755
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Entity Type | Individual
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Provider Name | JESSICA DIKHOW FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 26090 LANNYS ROAD
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City | NOVI
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State | MI
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Zip | 48375
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Country | US
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Telephone | 248-200-9420
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Fax |
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Provider Business Mailing Address
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Address Line | 6596 MINNOW POND DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2659
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704323933
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License Number State | MI
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