Healthcare Provider Details

I. General information

NPI: 1497666531
Provider Name (Legal Business Name): JOANNA MAY BERRIMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WILSON RD
EAST LANSING MI
48824-6410
US

IV. Provider business mailing address

34810 ERNEST ST
LIVONIA MI
48152-2978
US

V. Phone/Fax

Practice location:
  • Phone: 734-747-0989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: