Healthcare Provider Details

I. General information

NPI: 1760657613
Provider Name (Legal Business Name): CONSTANCE ANN BISKELONIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40600 ANN ARBOR RD E STE 201
PLYMOUTH MI
48170-4675
US

IV. Provider business mailing address

9817 ECKLES RD
PLYMOUTH MI
48170-4544
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 734-455-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704135860
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number47041356860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: