Healthcare Provider Details

I. General information

NPI: 1164071783
Provider Name (Legal Business Name): RYAN AMBER BEEBE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 06/03/2024
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17625 JOY RD
DETROIT MI
48228-1999
US

IV. Provider business mailing address

559 W GRAND BLVD
DETROIT MI
48216-2200
US

V. Phone/Fax

Practice location:
  • Phone: 313-446-8800
  • Fax: 313-446-8810
Mailing address:
  • Phone: 313-554-0485
  • Fax: 313-228-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704295116
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: