Healthcare Provider Details

I. General information

NPI: 1609990407
Provider Name (Legal Business Name): MURIEL GINAN SALLEE RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 E 7 MILE RD DETROIT HEALTH DEPT. - NORTHEAST HEALTH CENTER
DETROIT MI
48234-2461
US

IV. Provider business mailing address

8093 LARK LN
GRAND BLANC MI
48439-7252
US

V. Phone/Fax

Practice location:
  • Phone: 313-852-4232
  • Fax: 313-368-4694
Mailing address:
  • Phone: 810-655-5030
  • Fax: 313-368-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704150565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: