Healthcare Provider Details

I. General information

NPI: 1295290443
Provider Name (Legal Business Name): ASCENSION ST. JOHN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS, STE. 270
DETRIOT MI
48236
US

IV. Provider business mailing address

22201 MOROSS, STE. 270
DETRIOT MI
48236
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3481
  • Fax: 313-343-7937
Mailing address:
  • Phone: 313-343-3481
  • Fax: 313-343-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JULIE JOHANNSEN-WILK
Title or Position: REGISTERED CLINICAL DIETICIAN
Credential: RD
Phone: 313-343-3481