Healthcare Provider Details

I. General information

NPI: 1750801023
Provider Name (Legal Business Name): AMY MARIE BERTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39450 W TWELVE MILE RD STE 200
NOVI MI
48377-3600
US

IV. Provider business mailing address

39450 W TWELVE MILE RD STE 200
NOVI MI
48377-3600
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704263537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: