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General NPI Number Information
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NPI Number | 1396281234
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Entity Type | Individual
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Provider Name | THERA T RADNEY NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 20720 PLYMOUTH RD
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City | DETROIT
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State | MI
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Zip | 48228-1275
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Country | US
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Telephone | 313-493-4330
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Fax | 313-493-4419
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Provider Business Mailing Address
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Address Line | 28212 FRANKLIN RD
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1659
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Country | US
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Telephone | 248-356-5555
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Fax | 248-356-5544
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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 | 4704282153
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License Number State | MI
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