Individual provider · Type 1 NPI
Jusema Fantillo
Gerontology Registered Nurse · Detroit, MI
NPI number
1114654779
Active
Practice location
4646 John R St
Detroit, MI 48201-1916
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Registered Nurse Primary | 163WG0600X | 4704301171 (MI) |
Gerontology Registered Nurse: Definition to come...
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About NPI 1114654779
Jusema Fantillo's National Provider Identifier is 1114654779, issued on Aug 4, 2022. The primary taxonomy on file is Gerontology Registered Nurse (163WG0600X), and the practice location is in Detroit, MI. The record was last updated on Aug 4, 2022.