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General NPI Number Information
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NPI Number | 1639153075
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Entity Type | Individual
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Provider Name | LORETTA CATHERINE NIMMO C-FNP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3373 S. SAGINAW ST
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City | BURTON
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State | MI
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Zip | 48529
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Country | US
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Telephone | 810-237-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 ORE KNOB CT
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City | FENTON
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State | MI
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Zip | 48430-9373
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Country | US
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Telephone | 810-629-8859
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Fax | 810-629-1085
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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 | 4704064100
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License Number State | MI
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