Healthcare Provider Details

I. General information

NPI: 1497476006
Provider Name (Legal Business Name): CHRISTINA EZELL KIRKWOOD APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23077 GREENFIELD RD STE 200
SOUTHFIELD MI
48075-3750
US

IV. Provider business mailing address

23077 GREENFIELD RD STE 200
SOUTHFIELD MI
48075-3750
US

V. Phone/Fax

Practice location:
  • Phone: 313-824-1000
  • Fax:
Mailing address:
  • Phone: 269-492-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022042159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: