Healthcare Provider Details

I. General information

NPI: 1568127983
Provider Name (Legal Business Name): MISS VIYEZ NATRECE CHAMBLISS-CARUTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22170 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

IV. Provider business mailing address

22170 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

V. Phone/Fax

Practice location:
  • Phone: 248-372-6800
  • Fax:
Mailing address:
  • Phone: 248-372-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: