Healthcare Provider Details

I. General information

NPI: 1083556088
Provider Name (Legal Business Name): NANCY CAROL ENGELHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23500 PARK ST STE 4
DEARBORN MI
48124-2593
US

IV. Provider business mailing address

11461 CAPE COD ST
TAYLOR MI
48180-6208
US

V. Phone/Fax

Practice location:
  • Phone: 313-495-0704
  • Fax:
Mailing address:
  • Phone: 313-495-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: