Healthcare Provider Details

I. General information

NPI: 1659041127
Provider Name (Legal Business Name): IRSIDA XHIHANI MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 BOW POINTE DR STE 335
CLARKSTON MI
48346-5403
US

IV. Provider business mailing address

31500 TELEGRAPH ROAD SUITE 010
BINGHAM FARMS MI
48025
US

V. Phone/Fax

Practice location:
  • Phone: 248-707-3132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704325379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: