Healthcare Provider Details

I. General information

NPI: 1285203430
Provider Name (Legal Business Name): DANA VIX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA VIX

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RENAISSSANCE CENTER, SUITE 2600, PBM 2027
DETROIT MI
48243
US

IV. Provider business mailing address

400 RENAISSSANCE CENTER, SUITE 2600, PBM 2027
DETROIT MI
48243
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704299694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: