Healthcare Provider Details

I. General information

NPI: 1316544752
Provider Name (Legal Business Name): ABIGAIL LOUISE MERMUYS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E WEST MAPLE RD
WALLED LAKE MI
48390-3571
US

IV. Provider business mailing address

3102 ARBOR DR
FENTON MI
48430-3119
US

V. Phone/Fax

Practice location:
  • Phone: 248-313-2900
  • Fax:
Mailing address:
  • Phone: 810-241-9712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: