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General NPI Number Information
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NPI Number | 1205359106
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Entity Type | Individual
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Provider Name | ALEXANDREA JADE GARBUS CNM
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Gender | Female
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 4229 CASS AVE
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City | DETROIT
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State | MI
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Zip | 48201-1709
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Country | US
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Telephone | 313-831-7776
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Fax | 734-926-8987
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Provider Business Mailing Address
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Address Line | 2260 ELLWOOD AVE
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City | BERKLEY
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State | MI
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Zip | 48072-3204
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Country | US
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Telephone | 313-330-4013
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | CNM04202
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License Number State | MI
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