Healthcare Provider Details

I. General information

NPI: 1225462278
Provider Name (Legal Business Name): JULIE A HANSEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19714 E 10 MILE RD
SAINT CLAIR SHORES MI
48080-1064
US

IV. Provider business mailing address

39555 ORCHARD HILL PL STE 600
NOVI MI
48375-5381
US

V. Phone/Fax

Practice location:
  • Phone: 586-779-9400
  • Fax: 586-772-1440
Mailing address:
  • Phone: 586-779-9400
  • Fax: 586-772-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704190813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: