Healthcare Provider Details

I. General information

NPI: 1336599752
Provider Name (Legal Business Name): MARY BOJANIC-HELENSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15604 FARMINGTON RD
LIVONIA MI
48154-2852
US

IV. Provider business mailing address

15604 FARMINGTON RD
LIVONIA MI
48154-2852
US

V. Phone/Fax

Practice location:
  • Phone: 734-855-4176
  • Fax: 734-855-4178
Mailing address:
  • Phone: 734-855-4176
  • Fax: 734-855-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704286882
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704286882
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: