MEDICARE: WINNIE JEPKOGEI KOIMA NP

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	4704380659	MI
2	163W00000X	Registered Nurse	4704380659	MI

General Provider Information

NPI Number	:	1518773241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINNIE JEPKOGEI KOIMA NP

Provider Business Mailing Address
First Line	:	10201 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3149
Country	:	US
Telephone Number	:	734-237-7080
Fax Number	:	313-499-8389

Provider Business Practice Location Address
First Line	:	10201 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3149
Country	:	US
Telephone Number	:	734-237-7080
Fax Number	:	313-499-8389

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	03/10/2026

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