Healthcare Provider Details

I. General information

NPI: 1457188773
Provider Name (Legal Business Name): ERICA MARIE BEAVERS DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5557 CASS AVE
DETROIT MI
48202-3615
US

IV. Provider business mailing address

5557 CASS AVE
DETROIT MI
48202-3615
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-4082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704359787
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: