Jelinda Alyacoub, LPN

Individual provider Active NPI Licensed Practical Nurse · Madison Heights, MI

NPI 1124436803 · NPPES record last updated Apr 9, 2025

Key facts

NPI
1124436803
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
4703094696 (MI)
Practice address
28303 Dequindre Rd
Madison Heights, MI 48071-3040
Phone
(248) 658-1116
NPI assigned
Jul 26, 2014
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4703094696MIMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 4703094696 MI Yes

Addresses

Primary practice location

28303 Dequindre Rd
Madison Heights, MI 48071-3040

Mailing address

19911 N Great Oaks Cir
Clinton Township, MI 48036-2437
Phone (586) 741-8321

Other providers in Madison Heights, MI

All providers in Madison Heights, MI · Licensed Practical Nurse in Michigan

Sources for this page

Verify at the official NPI Registry.