=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538441928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIHAELA ZEGREAN ACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2011
-----------------------------------------------------
Last Update Date | 05/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4160 JOHN R ST 525
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-831-1100
-----------------------------------------------------
Fax | 313-831-1177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5565 WALKER RD
-----------------------------------------------------
City | OLDCASTLE
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | N0R1L0
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 15199916381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 4704247769
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------