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General NPI Number Information
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NPI Number | 1942333786
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTH MICHIGAN
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/08/2017
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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 | 313-692-8400
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Fax | 313-692-8431
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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 | 313-692-8400
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Fax | 313-692-8431
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. TAWANA L NETTLES-ROBINSON
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Credential |
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Telephone | 313-692-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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