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General NPI Number Information
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NPI Number | 1366976375
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Entity Type | Organization
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Legal Business Name | LEGARIUS
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD STE156
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 313-522-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 6424 SUMMER CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2234
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Country | US
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Telephone | 313-522-3939
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. DANYELLE SYVETTE ARMOUR
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Credential | NP
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Telephone | 313-522-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301055371
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704238009
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License Number State | MI
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