Healthcare Provider Details

I. General information

NPI: 1275444101
Provider Name (Legal Business Name): HEATHER MINOR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 AMESBURY DR
DAVISON MI
48423-1708
US

IV. Provider business mailing address

322 AMESBURY DR
DAVISON MI
48423-1708
US

V. Phone/Fax

Practice location:
  • Phone: 810-597-9990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704335304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: