Healthcare Provider Details

I. General information

NPI: 1093672784
Provider Name (Legal Business Name): SERAH M BUSU-SANGA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 VENTURE DR STE 400
ANN ARBOR MI
48108-9505
US

IV. Provider business mailing address

4750 VENTURE DR STE 400
ANN ARBOR MI
48108-9505
US

V. Phone/Fax

Practice location:
  • Phone: 734-778-7291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704326094NSA2512Y
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: