=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033659644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE ZAMLER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2017
-----------------------------------------------------
Last Update Date | 03/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14230 W MCNICHOLS RD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-966-2100
-----------------------------------------------------
Fax | 313-966-4916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2054 MAPLEHURST DR
-----------------------------------------------------
City | COMMERCE TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48390-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-481-4767
-----------------------------------------------------
Fax | 313-966-4645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 4704195173
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------