Healthcare Provider Details

I. General information

NPI: 1669239489
Provider Name (Legal Business Name): MARY LENA BOULOS-ALKHOURI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 VILLA LINDE PKWY
FLINT MI
48532-3423
US

IV. Provider business mailing address

5080 VILLA LINDE PKWY
FLINT MI
48532-3423
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-0162
  • Fax:
Mailing address:
  • Phone: 781-690-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704420564
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: