Healthcare Provider Details

I. General information

NPI: 1346304748
Provider Name (Legal Business Name): HEALTHLAND P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 VAN DYKE AVE STE H
WARREN MI
48093-7949
US

IV. Provider business mailing address

31700 VAN DYKE AVE STE H
WARREN MI
48093-7949
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-2911
  • Fax: 586-871-2036
Mailing address:
  • Phone: 586-445-2911
  • Fax: 586-871-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA VENNARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 586-445-2911