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General NPI Number Information
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NPI Number | 1316425424
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Entity Type | Individual
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Provider Name | JEANNE THERESE GUGUDIS NP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 2800 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2610
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Country | US
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Telephone | 313-799-6619
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Fax |
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Provider Business Mailing Address
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Address Line | 16705 WALTER ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-2984
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Country | US
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Telephone | 734-281-1543
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704176174
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License Number State | MI
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