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General NPI Number Information
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NPI Number | 1811456965
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Entity Type | Individual
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Provider Name | JACLYN LEE HUNT
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Gender | Female
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 2111 S SHORE DR SE APT 102
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City | KENTWOOD
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State | MI
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Zip | 49508-0907
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Country | US
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Telephone | 734-788-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 S SHORE DR SE APT 102
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City | KENTWOOD
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State | MI
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Zip | 49508-0907
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Country | US
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Telephone | 734-788-3183
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703115744
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License Number State | MI
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