Healthcare Provider Details

I. General information

NPI: 1225825524
Provider Name (Legal Business Name): ELIZABETH MCGORY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6889 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3415
US

IV. Provider business mailing address

5313 MOSER LN
PERRYSBURG OH
43551-7194
US

V. Phone/Fax

Practice location:
  • Phone: 248-677-5974
  • Fax:
Mailing address:
  • Phone: 419-357-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number4704421555
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036948
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: