Provider Demographics
NPI:1700392073
Name:GARRETT, JANALEE (LPN)
Entity Type:Individual
Prefix:
First Name:JANALEE
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29104 HAZELWOOD RD LOT 55
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9630
Mailing Address - Country:US
Mailing Address - Phone:313-701-0644
Mailing Address - Fax:
Practice Address - Street 1:300 N HURON ST STE 10
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2842
Practice Address - Country:US
Practice Address - Phone:734-480-0125
Practice Address - Fax:734-480-0015
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703108154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629279732Medicaid