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General NPI Number Information
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NPI Number | 1669791539
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Entity Type | Individual
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Provider Name | KASSANDRA L LUOMA
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Gender | Female
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 33475 PALMER RD
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City | WESTLAND
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State | MI
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Zip | 48186-4614
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Country | US
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Telephone | 734-728-2423
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Fax | 734-728-2183
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 947-522-1863
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Fax | 947-522-0307
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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 | 4704156833
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License Number State | MI
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