Healthcare Provider Details

I. General information

NPI: 1538073945
Provider Name (Legal Business Name): ASHLEE EDDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W WARREN AVE
DETROIT MI
48201-1347
US

IV. Provider business mailing address

136 AUDUBON DR
WHITE LAKE MI
48383-1704
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-2424
  • Fax:
Mailing address:
  • Phone: 248-534-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704365418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: