Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Jun 15, 2023
License(s)
4704324134 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1120 E LONG LAKE RD STE 120 | Troy, MI 48085-4998 | 248-946-9400 |
| MAILING | 1120 E LONG LAKE RD STE 120 | Troy, MI 48085-4998 | 248-946-9400 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.