Healthcare Provider Details

I. General information

NPI: 1437270154
Provider Name (Legal Business Name): LISA MCDONALD RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

18820 FOX
REDFORD MI
48240-1965
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-3180
  • Fax: 248-465-3181
Mailing address:
  • Phone: 734-754-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number4704223899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: