Healthcare Provider Details

I. General information

NPI: 1134663222
Provider Name (Legal Business Name): DORRIS NWAMMA NWAMBA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32605 W 12 MILE RD
FARMINGTON HILLS MI
48334-3337
US

IV. Provider business mailing address

22255 GREENFIELD RD
SOUTHFIELD MI
48075-3710
US

V. Phone/Fax

Practice location:
  • Phone: 313-306-2023
  • Fax:
Mailing address:
  • Phone: 248-559-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704271259
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704271259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: