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NPI Code Detail

MEDICARE: MRS. ELIZABETH ANN GUNN BS,DP-C

MEDICARE: MRS. ELIZABETH ANN GUNN BS,DP-C
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
1164W00000XLicensed Practical Nurse4703093776MI
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1518093657
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ANN GUNN BS,DP-C
Provider Business Mailing Address
First Line : 1255 N OAKLAND BLVD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-1545
Country : US
Telephone Number : 248-461-2910
Fax Number :
Provider Business Practice Location Address
First Line : 1255 N OAKLAND BLVD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-1545
Country : US
Telephone Number : 248-461-2910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2007
Last Update Date : 08/11/2022

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