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General NPI Number Information
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NPI Number | 1467164764
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Entity Type | Individual
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Provider Name | ELIZABETH HENSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 22631 GREATER MACK AVE STE 100
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2055
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Country | US
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Telephone | 586-800-0086
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Fax | 586-800-0087
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Provider Business Mailing Address
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Address Line | 22631 GREATER MACK AVE STE 100
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2055
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Country | US
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Telephone | 586-800-0086
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Fax | 586-800-0087
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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 | 4704321109
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License Number State | MI
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