Healthcare Provider Details

I. General information

NPI: 1467164764
Provider Name (Legal Business Name): ELIZABETH HENSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44300 5 MILE RD
NORTHVILLE MI
48168-9504
US

IV. Provider business mailing address

44300 5 MILE RD
NORTHVILLE MI
48168-9504
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-1883
  • Fax:
Mailing address:
  • Phone: 734-416-1883
  • Fax: 734-416-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704321109
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: