Healthcare Provider Details

I. General information

NPI: 1669993614
Provider Name (Legal Business Name): LEAH RENE FLANIGAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 N OAKLAND BLVD
WATERFORD MI
48327-1545
US

IV. Provider business mailing address

44300 5 MILE RD
NORTHVILLE MI
48168-9504
US

V. Phone/Fax

Practice location:
  • Phone: 738-416-1883
  • Fax:
Mailing address:
  • Phone: 738-416-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704218648
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704218648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: