Healthcare Provider Details

I. General information

NPI: 1184222572
Provider Name (Legal Business Name): NPH CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17330 NORTHLAND PARK CT
SOUTHFIELD MI
48075-4318
US

IV. Provider business mailing address

2222 W GRAND RIVER AVE
OKEMOS MI
48864-1604
US

V. Phone/Fax

Practice location:
  • Phone: 124-894-3453
  • Fax: 248-552-8144
Mailing address:
  • Phone: 248-943-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELIQUE D MOORE
Title or Position: NP
Credential: FNP
Phone: 248-943-4535