Healthcare Provider Details

I. General information

NPI: 1316329246
Provider Name (Legal Business Name): ASHRA MIRZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34020 7 MILE RD STE 101
LIVONIA MI
48152-3093
US

IV. Provider business mailing address

PO BOX 30148
BELFAST ME
04915-2053
US

V. Phone/Fax

Practice location:
  • Phone: 248-900-1555
  • Fax: 248-516-5017
Mailing address:
  • Phone: 888-488-8289
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704275007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: