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General NPI Number Information
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NPI Number | 1487368197
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Entity Type | Individual
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Provider Name | INDYA ELIZABETH PERRY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 22201 MOROSS RD ST JOHN PROF BLDG STE 170
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City | DETROIT
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State | MI
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Zip | 48236-2152
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Country | US
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Telephone | 313-886-8787
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Fax | 313-887-4103
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Provider Business Mailing Address
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Address Line | 22945 N BELLWOOD DR
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City | SOUTHFIELD
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State | MI
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Zip | 48034-6228
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Country | US
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Telephone | 248-506-0549
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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 | 4704317313
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License Number State | MI
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