Provider Demographics
NPI:1376669259
Name:SACCARO, JEANA
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:SACCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25360 SHIAWASSEE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-3861
Mailing Address - Country:US
Mailing Address - Phone:248-426-6890
Mailing Address - Fax:248-426-8160
Practice Address - Street 1:27634 WESTCOTT CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5350
Practice Address - Country:US
Practice Address - Phone:248-426-6890
Practice Address - Fax:248-426-8160
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704057613163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health