Provider Demographics
NPI:1750109542
Name:NEGRON, JAZZANAYA ALEXIS (CBD)
Entity type:Individual
Prefix:
First Name:JAZZANAYA
Middle Name:ALEXIS
Last Name:NEGRON
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2636
Mailing Address - Country:US
Mailing Address - Phone:313-486-4640
Mailing Address - Fax:
Practice Address - Street 1:7060 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2636
Practice Address - Country:US
Practice Address - Phone:313-486-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula