Healthcare Provider Details

I. General information

NPI: 1437540135
Provider Name (Legal Business Name): PATIENCE EKOGIAWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34290 FORD RD
WESTLAND MI
48185-3051
US

IV. Provider business mailing address

9366 SIL ST
TAYLOR MI
48180
US

V. Phone/Fax

Practice location:
  • Phone: 313-854-3148
  • Fax:
Mailing address:
  • Phone: 313-854-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704306291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: