Healthcare Provider Details

I. General information

NPI: 1720172000
Provider Name (Legal Business Name): AMY L KOMPERDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41850 W 11 MILE RD STE 202
NOVI MI
48375-1857
US

IV. Provider business mailing address

41850 W 11 MILE RD STE 202
NOVI MI
48375-1857
US

V. Phone/Fax

Practice location:
  • Phone: 248-860-4634
  • Fax: 248-282-5044
Mailing address:
  • Phone: 248-860-4634
  • Fax: 248-282-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704166490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: