Healthcare Provider Details

I. General information

NPI: 1124416284
Provider Name (Legal Business Name): VICKI L. MCNALLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKI L. SPEYER NP

II. Dates (important events)

Enumeration Date: 12/24/2014
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR STE 200
TROY MI
48098-6375
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-267-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704279535
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: