Basic Information
| Provider Information | |||||||||
| NPI: | 1669065348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALVAN | ||||||||
| FirstName: | JAMIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR STE J2000 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
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| Practice Location | |||||||||
| Address1: | IHA CANTON PRIMARY CARE | ||||||||
| Address2: | 1600 S CANTON CENTER RD SUITE 200 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343987880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2021 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704326620 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 4704326620 | MI | N | Nursing Service Providers | Registered Nurse |
No ID Information.