Healthcare Provider Details

I. General information

NPI: 1932803491
Provider Name (Legal Business Name): RACHEL EKLUND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

IV. Provider business mailing address

38608 LANCASTER CT
LIVONIA MI
48154-1300
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-0636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number4704216575
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704216575
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: