Provider Demographics
NPI:1598254344
Name:MEDVED, JERRI DEE (RN, MSN, CCMC)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:DEE
Last Name:MEDVED
Suffix:
Gender:F
Credentials:RN, MSN, CCMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SHERWOOD FOREST CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1677
Mailing Address - Country:US
Mailing Address - Phone:248-421-7633
Mailing Address - Fax:
Practice Address - Street 1:1327 SHERWOOD FOREST CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1677
Practice Address - Country:US
Practice Address - Phone:248-421-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704261182163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health