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General NPI Number Information
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NPI Number | 1669547774
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Entity Type | Organization
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Legal Business Name | HENRY FORD HEALTH SYSTEM
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29200 SCHOOLCRAFT RD OFFICE 2264
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City | LIVONIA
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State | MI
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Zip | 48150-2228
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Country | US
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Telephone | 734-523-8657
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Fax | 734-523-8667
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Provider Business Mailing Address
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Address Line | 8967 LAKEVIEW DR
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City | WHITE LAKE
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State | MI
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Zip | 48386-4143
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Country | US
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Telephone | 734-523-8657
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Fax | 734-523-8667
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Authorized Official
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Title or Position | CARDIOLOGY NURSE PRACTITIONER
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Name | MRS. MAGDALENA MARIA MAXEY
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Credential | N.P. MSN APRN-C
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Telephone | 734-523-8657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704113625
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License Number State | MI
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