Healthcare Provider Details

I. General information

NPI: 1154807410
Provider Name (Legal Business Name): ALYSSA ANN DENNIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 TOWN CENTER DR STE 106
TROY MI
48084-1744
US

IV. Provider business mailing address

130 TOWN CENTER DR STE 106
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-619-3100
  • Fax: 248-619-9031
Mailing address:
  • Phone: 248-619-3100
  • Fax: 248-619-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704284743
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: