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General NPI Number Information
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NPI Number | 1437182771
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Entity Type | Organization
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Legal Business Name | VA ANNARBOR HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2335
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Country | US
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Telephone | 734-769-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 15908 CRYSTAL DOWNS E
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City | NORTHVILLE
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State | MI
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Zip | 48168-8481
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Country | US
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Telephone | 734-737-0516
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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. MARY PATRICIA POUSAK
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Credential | RN,NP
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Telephone | 734-769-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4704190831
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License Number State | MI
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