Provider Demographics
NPI:1184466229
Name:BOBOESCU, JACQUELINE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BOBOESCU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8769 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5049
Mailing Address - Country:US
Mailing Address - Phone:734-679-7477
Mailing Address - Fax:
Practice Address - Street 1:8769 N TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-5049
Practice Address - Country:US
Practice Address - Phone:734-679-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330344363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health