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NPI Code Detail

MEDICARE: MRS. JESSICA JEANETTE MCLEOD NP

MEDICARE: MRS. JESSICA JEANETTE MCLEOD NP
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
1363LF0000XFamily Nurse Practitioner4704259470MI

General Provider Information

NPI Number : 1700163672
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA JEANETTE MCLEOD NP
Provider Business Mailing Address
First Line : 43151 DALCOMA DR
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-6306
Country : US
Telephone Number : 586-286-8720
Fax Number : 866-790-6803
Provider Business Practice Location Address
First Line : 2950 KEEWAHDIN RD
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3526
Country : US
Telephone Number : 810-455-1600
Fax Number : 810-455-1620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2011
Last Update Date : 12/12/2013

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