Healthcare Provider Details

I. General information

NPI: 1073197059
Provider Name (Legal Business Name): ALLISON MICHELLE FREDERICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

2006 HOGBACK RD STE 5A
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 248-585-3023
  • Fax: 248-585-3022
Mailing address:
  • Phone: 734-263-2395
  • Fax: 734-773-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704368392
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11026363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: