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General NPI Number Information
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NPI Number | 1124393202
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Entity Type | Organization
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Legal Business Name | IMAN NP CENTER LLC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 26771 W 12 MILE RD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1539
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Country | US
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Telephone | 248-595-8536
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Fax | 248-809-2043
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Provider Business Mailing Address
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Address Line | 26771 W 12 MILE RD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1539
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Country | US
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Telephone | 248-595-8536
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Fax | 248-809-2043
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | VERONICA SHIVACHI-WILLIAMS
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Credential | NP-C
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Telephone | 248-595-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | MI
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