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General NPI Number Information
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NPI Number | 1346329638
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Entity Type | Individual
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Provider Name | WENDY G GOLDBERG MSN, APRN, BC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-556-8736
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Fax | 313-879-1675
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Provider Business Mailing Address
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Address Line | 5615 SUTTERS LN
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-1057
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Country | US
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Telephone | 248-842-0158
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Fax | 313-879-1675
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704102520
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704102520
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License Number State | MI
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