Healthcare Provider Details

I. General information

NPI: 1598141046
Provider Name (Legal Business Name): SASHA SAMANTHA OHLDE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

7485 BUCKTHORN DR
WEST BLOOMFIELD MI
48324-2519
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-7000
  • Fax:
Mailing address:
  • Phone: 248-802-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704281569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: