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General NPI Number Information
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NPI Number | 1427868124
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Entity Type | Organization
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Legal Business Name | INNER PIECE
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 5735 SWAN LAKE DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1769
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Country | US
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Telephone | 810-610-8494
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Fax | 313-528-4841
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Provider Business Mailing Address
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Address Line | 5735 SWAN LAKE DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1769
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Country | US
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Telephone | 810-610-8494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA GOEDERT
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Credential | PMHNP-BC
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Telephone | 810-610-8494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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