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General NPI Number Information
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NPI Number | 1538655113
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Entity Type | Individual
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Provider Name | KENDRA NICOLE MANCINI AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2689
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Country | US
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Telephone | 313-916-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 3583 HOGAN CIR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5085
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Country | US
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Telephone | 248-770-9920
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704276096
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License Number State | MI
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