Healthcare Provider Details

I. General information

NPI: 1619487550
Provider Name (Legal Business Name): MRS. LANA ROSE ELIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 COMMERCE RD
COMMERCE TOWNSHIP MI
48382-4413
US

IV. Provider business mailing address

8800 COMMERCE RD
COMMERCE TOWNSHIP MI
48382-4413
US

V. Phone/Fax

Practice location:
  • Phone: 248-363-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704308098
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: