Jill Degoede
Individual provider Active NPI Registered Nurse · Delton, MI
NPI 1720536865 · NPPES record last updated Sep 19, 2016
Key facts
- NPI
- 1720536865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 4704278103 (MI)
- Practice address
- 11278 E Shore Dr
Delton, MI 49046-8482 - Phone
- (269) 720-4545
- NPI assigned
- Sep 19, 2016
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 4704278103 | MI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704278103 | MI | Yes |
Addresses
Primary practice location
11278 E Shore Dr
Delton, MI 49046-8482
Mailing address
11278 E Shore Dr
Delton, MI 49046-8482
Phone (269) 720-4545
Other providers in Delton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.