Healthcare Provider Details

I. General information

NPI: 1164993119
Provider Name (Legal Business Name): MEDLAW QUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 9 MILE RD STE 207
FERNDALE MI
48220-1750
US

IV. Provider business mailing address

195 W 9 MILE RD STE 207
FERNDALE MI
48220-1750
US

V. Phone/Fax

Practice location:
  • Phone: 313-405-3195
  • Fax:
Mailing address:
  • Phone: 313-405-3195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROLYN FRAZIER
Title or Position: ADMINISTRATOR
Credential: FNP-C
Phone: 313-405-3195