Healthcare Provider Details

I. General information

NPI: 1063596070
Provider Name (Legal Business Name): WENDY KATHERINE LEMERE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24555 HAIG ST
TAYLOR MI
48180-3322
US

IV. Provider business mailing address

2799 W GRAND BLVD K-11, NEUROLOGY
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-375-2170
  • Fax: 313-375-2166
Mailing address:
  • Phone: 313-916-3341
  • Fax: 313-916-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704159580
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: