Healthcare Provider Details

I. General information

NPI: 1639613730
Provider Name (Legal Business Name): ALYSON VIGNEAU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 AUTO CLUB DR FL 3
DEARBORN MI
48126-2749
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 313-317-2000
  • Fax:
Mailing address:
  • Phone: 313-874-4553
  • Fax: 517-803-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9712
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704284982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: