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Immanuel Jackson, DO
Student in an Organized Health Care Education/Training Program in Wyoming, Michigan
NPI 1598452864

Immanuel Jackson is a Student in an Organized Health Care Education/Training Program based in Wyoming, MI. Immanuel Jackson practices in Wyoming, MI and has the professional credentials of DO. The NPI Number for Immanuel Jackson is 1598452864 and holds a License No. (Michigan).

The current practice location address for Immanuel Jackson is 5900 Byron Center Ave Sw, Wyoming, MI and can be reached out via phone at 616-252-7200 and via fax at 616-252-4953.

Location: 5900 Byron Center Ave Sw, Wyoming, MI, 49519-9606
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1598452864
Provider Name
Immanuel Jackson
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
5900 Byron Center Ave Sw, Wyoming, MI, 49519-9606
Phone Number
616-252-7200
Fax Number
616-252-4953
Provider Enumeration Date
04/18/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
5900 Byron Center Ave Sw
City
Wyoming
State
Michigan
Zip
49519-9606
Phone Number
616-252-7200
Fax Number
616-252-4953
person
Provider Business Mailing Address Details
Address
5900 Byron Center Ave Sw
City
Wyoming
State
Michigan
Zip
49519-9606
Phone Number
616-252-7200
Fax Number
616-252-4953
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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