Healthcare Provider Details

I. General information

NPI: 1407289432
Provider Name (Legal Business Name): LAUREN SUSAN CASSISI BARBER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

IV. Provider business mailing address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

V. Phone/Fax

Practice location:
  • Phone: 248-206-8950
  • Fax: 248-206-8951
Mailing address:
  • Phone: 248-206-8950
  • Fax: 248-206-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704247426
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704247426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: