Healthcare Provider Details

I. General information

NPI: 1013845775
Provider Name (Legal Business Name): ANGELEE MARIE VAILE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26454 WOODWARD AVE STE 200
ROYAL OAK MI
48067-0969
US

IV. Provider business mailing address

25090 WOODWARD AVE APT 435
ROYAL OAK MI
48067-0997
US

V. Phone/Fax

Practice location:
  • Phone: 248-588-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704375546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: