Healthcare Provider Details

I. General information

NPI: 1871292151
Provider Name (Legal Business Name): KATHIE ANN PEREIRA MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 ELLSWORTH RD
YPSILANTI MI
48197-5619
US

IV. Provider business mailing address

7850 NEWBURY DR
YPSILANTI MI
48197-3195
US

V. Phone/Fax

Practice location:
  • Phone: 734-330-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704262695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: