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NPI Code Detail

MEDICARE: JEANNE JENNAE PRIDEMORE FNP-C

MEDICARE: JEANNE JENNAE PRIDEMORE FNP-C
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
1363L00000XNurse Practitioner4704325133MI

General Provider Information

NPI Number : 1871428334
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNE JENNAE PRIDEMORE FNP-C
Provider Business Mailing Address
First Line : 980 SEABURY DR
Second Line :
City : LAKE ORION
State : MI
Zip : 48362-1944
Country : US
Telephone Number : 248-330-1212
Fax Number :
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD
Second Line :
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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