Healthcare Provider Details

I. General information

NPI: 1407224769
Provider Name (Legal Business Name): AMY STROS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY BOWRON

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19251 MACK AVE SUITE 100
GROSSE POINTE WOODS MI
48236-2893
US

IV. Provider business mailing address

23400 24 MILE RD
MACOMB MI
48042-3322
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3740
  • Fax:
Mailing address:
  • Phone: 586-925-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704278384
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: