Provider Demographics
NPI:1144575895
Name:JOLISSAINT, REBECCA (DPM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JOLISSAINT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 STONEBRIDGE DR STE E
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5407
Mailing Address - Country:US
Mailing Address - Phone:810-230-9955
Mailing Address - Fax:
Practice Address - Street 1:2329 STONEBRIDGE DR STE E
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5407
Practice Address - Country:US
Practice Address - Phone:810-230-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002579213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery