JILL SIDANGE


Address: 24424 W Mcnichols Rd, Detroit, MI 48219-3653
Phone: 3135312500

JILL SIDANGE (NPI# 1588060750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1588060750
Entity Type Individual
Full Name JILL SIDANGE
Practice Address 24424 W Mcnichols Rd
Detroit
MI 48219-3653
Practice Telephone 3135312500
Enumeration Date 2014-11-14
Last Update Date 2015-10-14
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
4704265752 MI Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
MI N P SPECIALTY CERTIFICATE 4704265752 01

Office Location

Street Address 24424 W MCNICHOLS RD
City DETROIT
State MI
Zip Code 48219-3653

Providers in the same location

NPI Name Taxonomy Address Enumeration
1326135047 Development Centers, Inc. Social Worker 24424 W Mcnichols Rd, Detroit, MI 48219 2006-10-06
1083229249 Catrina Tookes Social Worker 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2020-09-14
1770198970 Wanda Mitchell Voluntary or Charitable 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2020-09-14
1295351161 Anna Marie Mier Social Worker 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2020-06-17
1275165797 Tenna Ramona Harris Social Worker 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2020-02-12
1780232835 Jamie Lee Ann Douglas Psychologist 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2019-09-02
1306491824 Stacy Lynette Saylor Social Worker 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2019-08-02
1821561960 Henry Lee Hampton Peer Specialist 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2019-01-10
1982174710 Claude Ray Winton II Peer Specialist 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2018-12-05
1164904009 Sarah Mcintire Peer Specialist 24424 W Mcnichols Rd, Detroit, MI 48219-3653 2018-09-06
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1891396008 Betty Jean Fairchild-el Home Health Aide 20018 Norhtrop, Detroit, MI 48219 2020-11-04
1134787633 Behavioral Health Professionals, Inc Family Medicine 19750 Burt Road, Detroit, MI 48219 2019-05-31
1255997755 Shvaughn Laniece Nunley Social Worker 18422 W Mcnichols Rd, Detroit, MI 48219 2019-05-10
1770081168 D & D Enterprise Group LLC Durable Medical Equipment & Medical Supplies 17405 Lahser, 202, Detroit, MI 48219 2018-01-31
1972011369 Fibers of The Family LLC Home Health 16800 Edinborough Rd, Detroit, MI 48219 2018-01-19
1871049684 Monique Jackson Occupational Therapist 21630 Jessel Ave, Detroit, MI 48219 2016-08-31
1114379773 Audrey Hopkins Licensed Practical Nurse 20277 Redfren, Detroit, MI 48219 2016-07-07
1649628785 Erin Bianco Social Worker 17321 Telegraph Rd., Detroit, MI 48219 2016-05-31
1144674664 Lucinda Galmon-wallace Technician, Other 24424 Telegraph Road, Detroit, MI 48219 2016-04-21
1598120925 Faith's Place LLC Psychiatric Residential Treatment Facility 16725 Blackstone Street, Detroit, MI 48219 2015-12-30
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1790293488 Infinity Hope Center LLC Nurse Practitioner 260 Vinewood St Ste 100a8919, Detroit, MI 48216-1667 2018-01-16
1033659644 Anne Zamler Nurse Practitioner 14230 W Mcnichols Rd, Detroit, MI 48235-3912 2017-03-01
1821180274 Carla J Groh Nurse Practitioner 5555 Conner, Suite 2691, Detroit, MI 48213 2006-09-29
1124054408 Patricia Frances Yourchock Orr Nurse Practitioner 4464 Burton St, Upper Unit, Detroit, MI 48210-2402 2006-06-25
1720619091 Sunshine Mental Health Care Nurse Practitioner 12871 E Jefferson Ave, Detroit, MI 48215-2754 2020-01-27
1720621535 Rebecca Anne Hibbs Nurse Practitioner 22101 Moross Rd, Detroit, MI 48236-2148 2019-10-24
1659895134 Infinity Hope Center Nurse Practitioner 277 Gratiot Ave Ste 100a8919, Detroit, MI 48226-2239 2017-07-27
1942685607 Eddia Marie Mcdade Nurse Practitioner 10 Peterboro St, Detroit, MI 48201-2722 2015-07-23
1043698475 Karen Ann Wezner Nurse Practitioner 2799 W Grand Blvd, Detroit, MI 48202-2608 2015-05-18
1285023226 Lauren Krist Nurse Practitioner 22151 Moross Rd, Detroit, MI 48236-2167 2015-01-14
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Competitor

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City DETROIT
Zip Code 48219

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Dataset Information

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.

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