Provider Demographics
NPI:1548629868
Name:ALLISON, JESSICA MARIE (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43301 COMMONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP.
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-482-8050
Mailing Address - Fax:586-276-5733
Practice Address - Street 1:43301 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1109
Practice Address - Country:US
Practice Address - Phone:586-482-8050
Practice Address - Fax:586-276-5733
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily