MEDICARE: MS. MICHELLE DENISE WILLIAMS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704244624	MI
2	163W00000X	Registered Nurse	470424624	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA
2	NA	OTHER	MI	NA

General Provider Information

NPI Number	:	1497347652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE DENISE WILLIAMS PMHNP

Provider Business Mailing Address
First Line	:	19321 SANT ROSA DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221
Country	:	US
Telephone Number	:	313-753-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	17950 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-2260
Country	:	US
Telephone Number	:	313-753-8927
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	05/03/2025

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