Healthcare Provider Details

I. General information

NPI: 1689207003
Provider Name (Legal Business Name): MANSI RAJPUROHIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

50569 AMBERWOOD RD
CANTON MI
48188-2580
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4400
  • Fax:
Mailing address:
  • Phone: 734-644-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number4704273041
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704273041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: