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General NPI Number Information
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NPI Number | 1891192159
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Entity Type | Individual
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Provider Name | MUNAZZA AHMED
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Gender | Female
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 29200 SCHOOLCRAFT ROAD
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City | LIVONIA
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State | MI
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Zip | 48150
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Country | US
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Telephone | 734-523-2433
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Fax |
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Provider Business Mailing Address
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Address Line | 38468 WATSON CIR
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City | WESTLAND
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State | MI
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Zip | 48186-5069
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Country | US
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Telephone | 313-505-5097
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704256561
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License Number State | MI
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