Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704259285 | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704259285 | MI |
NPI | 1083954770 |
---|---|
Provider Name | Andrew M Jablonowski |
First Address | Mount Clemens, MI 48043-2920 |
Second Address | Mount Clemens, MI 48043-2920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2013 |
Last Update Date | 18/03/2017 |