MEDICARE: EMILY NEENU JOHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704324489	MI

General Provider Information

NPI Number	:	1477416386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NEENU JOHN

Provider Business Mailing Address
First Line	:	1130 PARKER ST APT 711
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3941
Country	:	US
Telephone Number	:	313-268-5068
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 PARKER ST APT 711
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3941
Country	:	US
Telephone Number	:	313-268-5068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ EMILY NEENU JOHN ” Practice Location

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