Healthcare Provider Details

I. General information

NPI: 1750200937
Provider Name (Legal Business Name): ELIZABETH DANIELA MISKOTTEN RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 S CREEK DR
WIXOM MI
48393-1677
US

IV. Provider business mailing address

1214 S CREEK DR
WIXOM MI
48393-1677
US

V. Phone/Fax

Practice location:
  • Phone: 248-961-1775
  • Fax:
Mailing address:
  • Phone: 248-961-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704300705
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: