Provider Demographics
NPI:1457930349
Name:ALVERSON, JACKILYN DANIELLE (AGACNP)
Entity type:Individual
Prefix:
First Name:JACKILYN
Middle Name:DANIELLE
Last Name:ALVERSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
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Mailing Address - Street 1:804 SERVICE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-351-8377
Mailing Address - Fax:517-351-1738
Practice Address - Street 1:2700 BURCHAM DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3898
Practice Address - Country:US
Practice Address - Phone:517-351-8377
Practice Address - Fax:517-351-1738
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704289459363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care