Healthcare Provider Details

I. General information

NPI: 1023055019
Provider Name (Legal Business Name): LISA BINNS-EMERICK CNP, GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 ST ANTOINE STE 5B DRH ROSA PARKS WELLNESS INSTITUTE FOR SR HEALTH
DETROIT MI
48201
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400-CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1741
  • Fax: 313-745-8165
Mailing address:
  • Phone: 313-745-1741
  • Fax: 313-745-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704153550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: