Provider Demographics
NPI:1700163672
Name:MCLEOD, JESSICA JEANETTE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEANETTE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:43151 DALCOMA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:866-790-6803
Practice Address - Street 1:2950 KEEWAHDIN RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3526
Practice Address - Country:US
Practice Address - Phone:810-455-1600
Practice Address - Fax:810-455-1620
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704259470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily