Provider Demographics
NPI:1962637785
Name:FORD, JEANNE M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:M
Last Name:FORD
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 1:2619 PRODUCT DRIVE
Mailing Address - Street 2:# 106
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309
Mailing Address - Country:US
Mailing Address - Phone:248-844-9650
Mailing Address - Fax:248-844-9651
Practice Address - Street 1:2619 PRODUCT DR
Practice Address - Street 2:# 106
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3807
Practice Address - Country:US
Practice Address - Phone:248-844-9650
Practice Address - Fax:248-844-9651
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703090171164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse