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General NPI Number Information
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NPI Number | 1629687785
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Entity Type | Individual
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Provider Name | CATHERINE THERESE ENSWORTH AGNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 4800 S SAGINAW ST STE 1900
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City | FLINT
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State | MI
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Zip | 48507-2677
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Country | US
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Telephone | 586-484-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 50721 PINNACLE WOODS LN
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City | MACOMB
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State | MI
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Zip | 48042-5535
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Country | US
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Telephone | 586-484-8699
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704196169
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704196169
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License Number State | MI
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