Healthcare Provider Details

I. General information

NPI: 1831112085
Provider Name (Legal Business Name): AMY KRISTIN DZIURMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50505 SCHOENHERR RD STE 270
SHELBY TWP MI
48315-3141
US

IV. Provider business mailing address

50505 SCHOENHERR RD STE 270
SHELBY TOWNSHIP MI
48315-3141
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-6058
  • Fax: 586-500-8865
Mailing address:
  • Phone: 586-323-6085
  • Fax: 586-500-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704222700
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704222700
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number4704222700
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704222700
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: