Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501001061 | MI |
N | 2251C2600X | Cardiopulmonary | 5501001061 | MI |
NPI | 1558460436 |
---|---|
Provider Name | Ms. Jacqueline Frances Deron |
First Address | Ann Arbor, MI 48105-2303 |
Second Address | Ann Arbor, MI 48105-2335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 13/07/2007 |