Provider Demographics
NPI:1962015974
Name:VIEIRA, JOCELYN KIMBERLY (RN, AG-ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:KIMBERLY
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:RN, AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 KILDARE RD. LU
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ON
Mailing Address - Zip Code:N8Y3H1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32804 PIERCE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3215
Practice Address - Country:US
Practice Address - Phone:248-864-8585
Practice Address - Fax:248-864-8833
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303023363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty