Provider Demographics
NPI:1912597824
Name:NAFSO, JESSICA HANI
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HANI
Last Name:NAFSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5260
Mailing Address - Country:US
Mailing Address - Phone:248-853-2009
Mailing Address - Fax:248-853-4105
Practice Address - Street 1:215 E AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5260
Practice Address - Country:US
Practice Address - Phone:248-853-2009
Practice Address - Fax:248-853-4105
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310343363LF0000X
MI20328075423164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse