Healthcare Provider Details

I. General information

NPI: 1649372608
Provider Name (Legal Business Name): LAURA ANN DANSEL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 FOREST AVE SUITE 7A
PLYMOUTH MI
48170-1775
US

IV. Provider business mailing address

3506 BURBANK DR
ANN ARBOR MI
48105-1596
US

V. Phone/Fax

Practice location:
  • Phone: 734-446-5466
  • Fax:
Mailing address:
  • Phone: 734-748-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704134356
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704134356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: