Healthcare Provider Details

I. General information

NPI: 1437495298
Provider Name (Legal Business Name): ANTHONY DAVID DILORETO PMHNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 W WALTON BLVD
WATERFORD MI
48329-4905
US

IV. Provider business mailing address

4576 W WALTON BLVD
WATERFORD MI
48329-4905
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-3920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704277277
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704267277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: