Healthcare Provider Details

I. General information

NPI: 1316376700
Provider Name (Legal Business Name): JOANNE SUSAN SEDOR RN, MSN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W LONG LAKE RD APT F5
BLOOMFIELD HILLS MI
48302-2065
US

IV. Provider business mailing address

801 W LONG LAKE RD APT F5
BLOOMFIELD HILLS MI
48302-2065
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-4187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number4704061830
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704061830
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: