MEDICARE: SITHARA JAISON N.P

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
1	363L00000X	Nurse Practitioner	4704268025	MI
2	363LF0000X	Family Nurse Practitioner	4704268025	MI

General Provider Information

NPI Number	:	1982094074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SITHARA JAISON N.P

Provider Business Mailing Address
First Line	:	426 WESTBROOK
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 WESTBROOK
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8211
Country	:	US
Telephone Number	:	734-550-2002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	02/20/2018

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Directions to “ SITHARA JAISON N.P” Practice Location

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