Healthcare Provider Details

I. General information

NPI: 1083966220
Provider Name (Legal Business Name): DONNA S. BEAL-LLOYD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 TAYLOR ST
DETROIT MI
48202-1732
US

IV. Provider business mailing address

18254 MIDWAY AVE
SOUTHFIELD MI
48075-7137
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4828
  • Fax:
Mailing address:
  • Phone: 248-569-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704177424
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704177424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: