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General NPI Number Information
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NPI Number | 1184187528
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Entity Type | Individual
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Provider Name | MONIKA KATARZYNA MALYSA-HOUBEN NP STUDENT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 249-849-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 7778 VISGER AVE
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City | WATERFORD
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State | MI
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Zip | 48329-1066
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Country | US
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Telephone | 248-252-3838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704259928
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704259928
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License Number State | MI
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