Provider Demographics
NPI:1073058509
Name:JEAN, CHRISTINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MIRITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 SUMPTER RD STE 483
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4905
Mailing Address - Country:US
Mailing Address - Phone:734-365-1941
Mailing Address - Fax:
Practice Address - Street 1:18355 PINE WEST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48193
Practice Address - Country:US
Practice Address - Phone:734-365-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704360616163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice