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General NPI Number Information
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NPI Number | 1861213423
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Entity Type | Individual
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Provider Name | JACQUELYN ELDER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 2650 CARPENTER RD
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City | ANN ARBOR
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State | MI
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Zip | 48108-1108
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Country | US
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Telephone | 734-971-1073
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Fax | 614-635-1290
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Provider Business Mailing Address
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Address Line | 777 STONEY DR
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City | SOUTH LYON
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State | MI
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Zip | 48178-2022
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4704328292
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License Number State | MI
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