Healthcare Provider Details

I. General information

NPI: 1982517249
Provider Name (Legal Business Name): CHRISTINE MAYEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

IV. Provider business mailing address

4365 HURON CHURCH LINE
LASALLE ONTARIO
N9H1H3
CA

V. Phone/Fax

Practice location:
  • Phone: 313-916-0466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number4704316997NSA260V0
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: