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General NPI Number Information
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NPI Number | 1689266702
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Entity Type | Individual
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Provider Name | THERTULEINE NANA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 48300 W 11 MILE RD
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City | NOVI
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State | MI
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Zip | 48374-1718
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Country | US
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Telephone | 248-662-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 51218 MAYFAIR TER
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City | NOVI
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State | MI
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Zip | 48374-1019
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Country | US
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Telephone | 248-704-5302
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704316518
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704316518
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License Number State | MI
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