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General NPI Number Information
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NPI Number | 1760561062
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF DETROIT MERCY
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 5555 CONNER ST STE 2691
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City | DETROIT
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State | MI
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Zip | 48213-3448
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Country | US
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Telephone | 313-579-1182
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Fax | 313-579-5128
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Provider Business Mailing Address
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Address Line | 5555 CONNER ST STE 2691
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City | DETROIT
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State | MI
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Zip | 48213-3448
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Country | US
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Telephone | 313-579-1182
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Fax | 313-579-5128
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Authorized Official
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Title or Position | CLINIC COORDINATOR / NP
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Name | MRS. TRACEY ELIZABETH CHAN
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Credential | APRN-BC
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Telephone | 313-579-1182
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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 |
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License Number State | MI
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