=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649136714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHIGAN MOBILE FORENSICS 1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2026
-----------------------------------------------------
Last Update Date | 01/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10260 S SHERIDAN RD
-----------------------------------------------------
City | FENWICK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48834-9776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-719-7260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10220 W HERBISON RD
-----------------------------------------------------
City | EAGLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48822-9743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-719-7260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER
-----------------------------------------------------
Name | JILL HICKS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 517-719-7260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------