Provider Demographics
NPI:1730530619
Name:MCCREE, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MCCREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3509
Mailing Address - Country:US
Mailing Address - Phone:248-291-4281
Mailing Address - Fax:
Practice Address - Street 1:3521 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3509
Practice Address - Country:US
Practice Address - Phone:248-291-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI133VN1004X
MI4704180803163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric