Healthcare Provider Details

I. General information

NPI: 1902753536
Provider Name (Legal Business Name): CHARLI MARTHA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W. OUTER DRIVE
DETROIT MI
48219
US

IV. Provider business mailing address

17324 WASHBURN ST
DETROIT MI
48221-2441
US

V. Phone/Fax

Practice location:
  • Phone: 734-363-7307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704334299
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number4704334299
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number4704334299
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: