Healthcare Provider Details

I. General information

NPI: 1487575957
Provider Name (Legal Business Name): MAYGEN OHERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 IROQUOIS TRL
MONROE MI
48162-4526
US

IV. Provider business mailing address

3504 IROQUOIS TRL
MONROE MI
48162-4526
US

V. Phone/Fax

Practice location:
  • Phone: 734-755-3806
  • Fax:
Mailing address:
  • Phone: 734-755-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703104640
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: