Healthcare Provider Details

I. General information

NPI: 1942896253
Provider Name (Legal Business Name): MONIKA CLAY AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 SOUTH BLVD E STE 1200
ROCHESTER HILLS MI
48307-5364
US

IV. Provider business mailing address

36355 HAMMER LN
LIVONIA MI
48152-2758
US

V. Phone/Fax

Practice location:
  • Phone: 248-705-6223
  • Fax:
Mailing address:
  • Phone: 734-620-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704276249
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704276249
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704276249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: