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General NPI Number Information
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NPI Number | 1447728076
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Entity Type | Individual
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Provider Name | MICHELLE BERCILES VILLAREAL FNP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 2221 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-1603
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Country | US
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Telephone | 248-250-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 561 W SARATOGA ST
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City | FERNDALE
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State | MI
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Zip | 48220-3339
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Country | US
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Telephone | 586-439-8668
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Fax |
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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 | 4704298684
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License Number State | MI
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