Healthcare Provider Details

I. General information

NPI: 1972934941
Provider Name (Legal Business Name): MIREILLE TOUMA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18320 FARMINGTON RD
LIVONIA MI
48152
US

IV. Provider business mailing address

18320 FARMINGTON RD
LIVONIA MI
48152
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-9200
  • Fax:
Mailing address:
  • Phone: 248-476-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704179048
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number47041 79048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: