Healthcare Provider Details

I. General information

NPI: 1104641620
Provider Name (Legal Business Name): CHRISTINA PLOEGER DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

IV. Provider business mailing address

932 BONHOMME CT
PORT HURON MI
48060-2108
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704322488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: