Healthcare Provider Details

I. General information

NPI: 1851801930
Provider Name (Legal Business Name): MARICELA HERMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11368 ALLEN RD
TAYLOR MI
48180-4372
US

IV. Provider business mailing address

4211 SPRING LAKE BLVD
ANN ARBOR MI
48108-9666
US

V. Phone/Fax

Practice location:
  • Phone: 734-403-2222
  • Fax:
Mailing address:
  • Phone: 714-889-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704276999
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: