Healthcare Provider Details

I. General information

NPI: 1043261985
Provider Name (Legal Business Name): DOROTHY HELEN RODRIGUEZ ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOTTIE RODRIGUEZ RN, MSN

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N PERRY ST
PONTIAC MI
48342-2217
US

IV. Provider business mailing address

3145 DIXIE HWY
WATERFORD MI
48328-1602
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-5210
  • Fax: 248-338-5584
Mailing address:
  • Phone: 248-338-5000
  • Fax: 248-338-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704167051
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704167051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: