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NPI Code Detail

MEDICARE: JONATHAN DELTON STAFFORD CHW

MEDICARE: JONATHAN DELTON STAFFORD CHW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerMI

General Provider Information

NPI Number : 1386424711
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN DELTON STAFFORD CHW
Provider Business Mailing Address
First Line : 2955 PHEASANT RUN DR
Second Line :
City : JACKSON
State : MI
Zip : 49202-1344
Country : US
Telephone Number : 517-885-5238
Fax Number :
Provider Business Practice Location Address
First Line : 500 N JACKSON ST
Second Line :
City : JACKSON
State : MI
Zip : 49201-1223
Country : US
Telephone Number : 517-748-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2023
Last Update Date : 10/03/2023

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Directions to “ JONATHAN DELTON STAFFORD CHW” Practice Location

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