Healthcare Provider Details

I. General information

NPI: 1114457868
Provider Name (Legal Business Name): FATME A ANCOUNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23713 STERLING PL
DEARBORN MI
48124-1669
US

IV. Provider business mailing address

23713 STERLING PL
DEARBORN MI
48124-1669
US

V. Phone/Fax

Practice location:
  • Phone: 313-414-3093
  • Fax:
Mailing address:
  • Phone: 313-414-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801114479
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: