Healthcare Provider Details

I. General information

NPI: 1255957437
Provider Name (Legal Business Name): NADA MOHAMED RAMADAN MSN, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MACK AVE STE 1
DETROIT MI
48201-2136
US

IV. Provider business mailing address

400 MACK AVE STE 1
DETROIT MI
48201-2136
US

V. Phone/Fax

Practice location:
  • Phone: 313-448-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704333470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: