Healthcare Provider Details

I. General information

NPI: 1114590932
Provider Name (Legal Business Name): FARHIA DZANDU NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45300 CHERRY HILL RD
CANTON MI
48187-5073
US

IV. Provider business mailing address

45300 CHERRY HILL RD
CANTON MI
48187-5073
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-3968
  • Fax:
Mailing address:
  • Phone: 734-981-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704303472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: