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General NPI Number Information
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NPI Number | 1043726144
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Entity Type | Organization
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Legal Business Name | NP PROVISION, LLC
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 27177 LAHSER RD STE 201
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8468
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Country | US
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Telephone | 248-895-8562
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Fax | 248-286-6255
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Provider Business Mailing Address
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Address Line | 220 MAIN SAIL CT
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City | DETROIT
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State | MI
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Zip | 48207-5008
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Country | US
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Telephone | 313-587-3087
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Fax | 248-286-6255
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Authorized Official
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Title or Position | PROPRIETOR/NURSE PRACTITIONER
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Name | MRS. TIMIKO L DREW
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Credential | NP-C
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Telephone | 313-587-3087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704177492
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License Number State | MI
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