Healthcare Provider Details

I. General information

NPI: 1942517859
Provider Name (Legal Business Name): MS. JOHNELLA FITZPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 TOWN CENTER DR
HIGHLAND PARK MI
48203-3683
US

IV. Provider business mailing address

284 TOWN CENTER DR
HIGHLAND PARK MI
48203-3683
US

V. Phone/Fax

Practice location:
  • Phone: 313-728-1792
  • Fax:
Mailing address:
  • Phone: 313-728-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number140073
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230011417371005
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: