Healthcare Provider Details

I. General information

NPI: 1013781251
Provider Name (Legal Business Name): ELLEN TAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 W BIG BEAVER RD STE 150
TROY MI
48084-2931
US

IV. Provider business mailing address

8348 18 MILE RD APT 1
STERLING HEIGHTS MI
48313-3003
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-6527
  • Fax:
Mailing address:
  • Phone: 815-218-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704348446
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: