Organization · NPI-2
Iman NP Center LLC
Clinic/Center · Southfield, MI
NPI number1124393202
StatusActive
Last updated in NPPESAug 6, 2012
Details
- NPI
- 1124393202
- Entity type
- Organization (NPI-2)
- Legal business name
- Iman NP Center LLC
- Organization subpart
- No
- Enumeration date
- Mar 21, 2012
- Last updated
- Aug 6, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | MI | Yes |
| 367A00000X | Advanced Practice Midwife | – | – | |
| 363LP0200X | Nurse Practitioner, Pediatrics | – | – | |
| 363LP2300X | Nurse Practitioner, Primary Care | – | – | |
| 363LA2200X | Nurse Practitioner, Adult Health | – | – |
Other names
- Iman Nurse Practitioner Center (Other Name)
Practice location
26771 W 12 Mile RdSuite 101
Southfield, MI 48034-1539
Phone 248-595-8536 · Fax 248-809-2043
Mailing address
26771 W 12 Mile RdSuite 101
Southfield, MI 48034-1539
Phone 248-595-8536 · Fax 248-809-2043
Authorized official
Veronica Shivachi-Williams
Nurse Practitioner
2485958536
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