Elan Vitale Healthy Living Solutions
Nurse Practitioner in Dearborn Hts, MI. Organization (NPI-2).
NPI number1982107140
StatusActive
Last updated in NPPESMar 14, 2018
Details
- NPI
- 1982107140
- Entity type
- Organization (NPI-2)
- Legal business name
- Elan Vitale Healthy Living Solutions
- Organization subpart
- No
- Enumeration date
- Mar 14, 2018
- Last updated
- Mar 14, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 4704170920 | MI | Yes |
Practice location
27247 Joy RdDearborn Hts, MI 48127-1022
Phone 248-667-6307
Mailing address
27247 Joy RdDearborn Hts, MI 48127-1022
Authorized official
Jackie Duncan
Nurse Practitioner
2486672531
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