Healthcare Provider Details

I. General information

NPI: 1578055349
Provider Name (Legal Business Name): LAURIE-ANN CADENE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 W 8 MILE RD
FERNDALE MI
48220-2100
US

IV. Provider business mailing address

10300 W 8 MILE RD
FERNDALE MI
48220-2100
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-3200
  • Fax: 248-691-4963
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704279753
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: