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General NPI Number Information
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NPI Number | 1306394580
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Entity Type | Individual
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Provider Name | ELISE DANIELLE FODOR MSN, RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1380 COOLIDGE HWY STE 110
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City | TROY
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State | MI
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Zip | 48084-7067
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Country | US
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Telephone | 248-280-1867
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Fax | 248-280-0222
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Provider Business Mailing Address
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Address Line | 4230 LOU MAR LN
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City | LAKE ORION
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State | MI
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Zip | 48359-1905
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Country | US
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Telephone | 248-202-3599
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704268877
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License Number State | MI
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