Healthcare Provider Details

I. General information

NPI: 1902227341
Provider Name (Legal Business Name): RENEE MCLEAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FORT ST EMERGENCY DEPT
TRENTON MI
48183-4601
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-3883
  • Fax: 734-467-5500
Mailing address:
  • Phone: 734-805-0488
  • Fax: 866-250-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704272615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: