=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487178174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY AMIRA YOUSIF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2017
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6501 EAST 11 MILE RD BLDG 230, RM 134W
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48397-3852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-282-5771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39281 TWENLOW DR
-----------------------------------------------------
City | CLINTON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48038-5706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-912-5091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704282774
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------