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General NPI Number Information
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NPI Number | 1811399652
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Entity Type | Individual
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Provider Name | CAROLYN ADAEZE IBE DNP, APRN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 3990 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-2097
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Country | US
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Telephone | 313-745-8694
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 ORLEANS ST APT 1910
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City | DETROIT
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State | MI
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Zip | 48207-3198
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Country | US
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Telephone | 313-629-9684
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704294466
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License Number State | MI
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