Healthcare Provider Details

I. General information

NPI: 1033217856
Provider Name (Legal Business Name): TRICOUNTY NURSES PLUS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8538 ISLAND BLVD
GROSSE ILE MI
48138
US

IV. Provider business mailing address

410 W JEFFERSON AVE
TRENTON MI
48183-1217
US

V. Phone/Fax

Practice location:
  • Phone: 734-377-7194
  • Fax: 734-281-1357
Mailing address:
  • Phone: 734-281-0695
  • Fax: 734-281-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703076324
License Number StateMI

VIII. Authorized Official

Name: DEBORAH TERESA MACDONALD
Title or Position: CEO
Credential: LPN
Phone: 734-377-7194