Healthcare Provider Details

I. General information

NPI: 1063324473
Provider Name (Legal Business Name): ANNA JEMIMA BONSRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W MAPLE RD
CLAWSON MI
48017-1109
US

IV. Provider business mailing address

2534 PATRICK HENRY ST
AUBURN HILLS MI
48326-2325
US

V. Phone/Fax

Practice location:
  • Phone: 248-629-6084
  • Fax: 248-629-6070
Mailing address:
  • Phone: 248-707-9965
  • Fax: 248-707-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704378618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: