Jackie Walgram, RN/HEALTH EDUCATOR
Individual provider Active NPI Health Educator · Coloma, MI
NPI 1740436286 · NPPES record last updated Aug 14, 2019
Key facts
- NPI
- 1740436286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Health Educator 174H00000X
- License
- 4704132716 (MI)
- Practice address
- 4881 Wil O Paw Dr
Coloma, MI 49038-8816 - Phone
- (269) 325-5659
- NPI assigned
- Aug 15, 2008
- Reactivated
- Jul 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704132716 | MI | MD | Health Educator |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | 4704132716 | MI | Yes |
Addresses
Primary practice location
4881 Wil O Paw Dr
Coloma, MI 49038-8816
Mailing address
4881 Wil O Paw Dr
Coloma, MI 49038-8816
Phone (269) 569-4509
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704132716 | Other | MI | LICENSE |
Other names
- Ms. Jackie Howard
Other providers in Coloma, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2019. 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.