Healthcare Provider Details

I. General information

NPI: 1669844254
Provider Name (Legal Business Name): PAULA FORSHUN MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23660 EUREKA RD
TAYLOR MI
48180-5275
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-250-9630
  • Fax: 734-250-9631
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704226981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: