MR. JERRY IDICULLA CHANDY (NPI# 1023447695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023447695 |
| Entity Type | Individual |
| Full Name | MR. JERRY IDICULLA CHANDY |
| Credential | N.P. |
| Practice Address |
1675 Kingsway Ct Ste 1 Trenton MI 48183-1958 |
| Practice Telephone | 7346768530 |
| Mailing Telephone | 7346768530 |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
4704276954 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1675 KINGSWAY CT STE 1 |
| City | TRENTON |
| State | MI |
| Zip Code | 48183-1958 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043869324 | Tonya Saint Onge | Physical Therapy Assistant | Applewood Nursing Center, 18500 Van Horn Rd., Woodhaven, MI 48183 | 2019-09-09 |
| 1326568635 | Samantha Nicole Steffen | Behavior Technician | 3244 Concord, Trenton, MI 48183 | 2017-06-27 |
| 1225567688 | Nicholas Michael Abdallah | Dentist | 21080 Allen Road, Woodhaven, MI 48183 | 2017-06-08 |
| 1265823041 | Sherry A Dees Lmsw Acsw LLC | Counselor | 23933 Allen Road, Suite 3, Woodhaven, MI 48183 | 2015-02-14 |
| 1720480825 | Marlo Brazier | Technician, Other | 226000 West Rd, Apt 108, Trenton, MI 48183 | 2014-09-19 |
| 1679902597 | Henry Ford Wyandotte Hospital | Dietitian, Registered | 1640 Fort Street, Suite D Attn Denise, Trenton, MI 48183 | 2013-11-02 |
| 1548605116 | Kay Vonne Cason Psy Pllc | Psychologist | 19366 Allen Rd Ste. D, Brownstown, MI 48183 | 2013-05-08 |
| 1891031118 | Mazin K Dds PC | Dentist | 22319 King Rd, Woodhaven, MI 48183 | 2012-12-13 |
| 1114241585 | John Shafer | Psychologist | 1660 Fort St, Trenton, MI 48183 | 2010-03-15 |
| 1982871026 | Anthony G Gray | Physical Therapist | 20059 King Road, Woodhaven, MI 48183 | 2008-05-08 |
| Find all providers in zip 48183 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801440359 | Jeannette Oliveras | Nurse Practitioner | 218 North Broad St., Trenton, NJ 08609 | 2019-08-01 |
| 1790255941 | Susan Heather Lake | Nurse Practitioner | 1618 Riverside Drive, Trenton, NJ 08618 | 2018-11-30 |
| 1629432315 | Liqin Zhang | Nurse Practitioner | 2065 Klockner Rd., Trenton, NJ 08690 | 2016-04-08 |
| 1346444239 | Carolyn Elaine Lewis-spruill | Nurse Practitioner | 218 N Broad St, Trenton, NJ 08608-1306 | 2007-06-13 |
| 1326010034 | David Bokor | Nurse Practitioner | 383 W State St, Trenton, NJ 08618-5705 | 2006-02-06 |
| 1043753502 | Staci Damiani | Nurse Practitioner | 1675 Kingsway Ct, Trenton, MI 48183-1958 | 2016-11-30 |
| 1326477084 | Laura Fodor | Nurse Practitioner | 3851 West Rd, Suite 2, Trenton, MI 48183-2350 | 2013-11-04 |
| 1619300456 | Michelle Bostic | Nurse Practitioner | 750 Brunswick Ave, Neuroscience Office, Trenton, NJ 08638-4143 | 2013-08-15 |
| 1235437831 | Lisa Ranea Dugas | Nurse Practitioner | 3700 West Rd, Trenton, MI 48183-2243 | 2011-03-05 |
| 1235397605 | Baaba Forson | Nurse Practitioner | 321 N Warren St, Trenton, NJ 08618-4741 | 2008-06-01 |
| Find all providers in TRENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.