Provider Demographics
NPI:1063490456
Name:JOSEY, JEANNE (NP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:JOSEY
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 1:3120 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5131
Mailing Address - Country:US
Mailing Address - Phone:734-677-6000
Mailing Address - Fax:734-677-2422
Practice Address - Street 1:3120 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5131
Practice Address - Country:US
Practice Address - Phone:734-677-6000
Practice Address - Fax:734-677-2422
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4257020Medicaid
MI11-4915486Medicaid
MI38-2523696-001OtherTRICARE MHP ANNAPOLIS
MIP21204Medicare UPIN
MI10-4257049Medicaid
MI10-4257030Medicaid
MI10-4257058Medicaid
MI10-4257011Medicaid