Provider Demographics
NPI:1740579317
Name:PRO NURSE LLC
Entity Type:Organization
Organization Name:PRO NURSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-458-7495
Mailing Address - Street 1:15200 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 101G
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1304
Mailing Address - Country:US
Mailing Address - Phone:313-458-7495
Mailing Address - Fax:313-458-7592
Practice Address - Street 1:15200 E JEFFERSON AVE
Practice Address - Street 2:SUITE 101G
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1304
Practice Address - Country:US
Practice Address - Phone:313-458-7495
Practice Address - Fax:313-458-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care