Healthcare Provider Details

I. General information

NPI: 1891680468
Provider Name (Legal Business Name): QUENYA WALEGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50505 SCHOENHERR RD STE 340
SHELBY TOWNSHIP MI
48315-3140
US

IV. Provider business mailing address

36530 KELLY RD
CLINTON TOWNSHIP MI
48035-1319
US

V. Phone/Fax

Practice location:
  • Phone: 586-876-9776
  • Fax: 586-731-8406
Mailing address:
  • Phone: 586-876-9776
  • Fax: 586-731-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704349386
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704349386
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: