Healthcare Provider Details

I. General information

NPI: 1922526029
Provider Name (Legal Business Name): ANNETT UDUJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 REECK CT
SOUTHGATE MI
48195-3197
US

IV. Provider business mailing address

31500 SCHOOLCRAFT RD
LIVONIA MI
48150-1805
US

V. Phone/Fax

Practice location:
  • Phone: 734-225-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704225832
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704225832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: