Provider Demographics
NPI:1104272160
Name:GIDEON, JENNIFER M (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:GIDEON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:STE 917
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-745-0011
Practice Address - Street 1:1560 E MAPLE RD
Practice Address - Street 2:SUITE 400 - CREDENTIALING
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1138
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704139802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily