Provider Demographics
NPI:1407342926
Name:MEYERS, JESSICA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MEYERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1535
Mailing Address - Country:US
Mailing Address - Phone:313-492-7021
Mailing Address - Fax:
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-624-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICNM04585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse