Healthcare Provider Details

I. General information

NPI: 1205749678
Provider Name (Legal Business Name): HELEN EBURUCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28800 VAN DYKE AVE
WARREN MI
48093-2747
US

IV. Provider business mailing address

4590 VALLEYVIEW DR
WEST BLOOMFIELD MI
48323-3354
US

V. Phone/Fax

Practice location:
  • Phone: 586-467-5004
  • Fax:
Mailing address:
  • Phone: 313-964-9100
  • Fax: 248-365-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704235276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: