Healthcare Provider Details

I. General information

NPI: 1972808541
Provider Name (Legal Business Name): KADY SUZEANNE OWENS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30795 23 MILE RD STE 208
CHESTERFIELD MI
48047-5721
US

IV. Provider business mailing address

6831 SAINT CLAIR DR
TROY MI
48098-6906
US

V. Phone/Fax

Practice location:
  • Phone: 586-421-3160
  • Fax:
Mailing address:
  • Phone: 313-320-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704259860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: