Healthcare Provider Details

I. General information

NPI: 1669348827
Provider Name (Legal Business Name): BEYRUT CRUZ VAN HET HOF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W VERNOR HWY STE 1A
DETROIT MI
48209-3420
US

IV. Provider business mailing address

3400 E LAFAYETTE ST
DETROIT MI
48207-4962
US

V. Phone/Fax

Practice location:
  • Phone: 313-889-2000
  • Fax: 313-889-3000
Mailing address:
  • Phone: 432-202-6440
  • Fax: 888-649-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704312755
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704312755
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: