NPI 1396505335

Jacob Prevost

Practitioner Chore Provider Burtchville, MI

Practice location

Address: 6117 Old Country Ln, Burtchville, MI 48059-2415
Phone: (810) 388-1200
Mailing address: 2609 17th Ave, Port Huron, MI 48060-2724

Registered specialties

Chore Provider Primary

Nursing Service Related Providers Taxonomy 372500000X

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Registry record

NPI: 1396505335
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Mar 2024
Record last updated: 19 Mar 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.