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NPI Code Detail

MEDICARE: SALLY RAE ARBUCKLE RN, NPC

MEDICARE: SALLY RAE ARBUCKLE RN, NPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WN0002XNeonatal Intensive Care Registered Nurse4704076259MI
2364SN0000XNeonatal Clinical Nurse Specialist4704076259MI
3363LN0000XNeonatal Nurse Practitioner4704076259MI
4363LN0005XCritical Care Neonatal Nurse Practitioner4704076259MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114929338
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY RAE ARBUCKLE RN, NPC
Provider Business Mailing Address
First Line : 16001 W 9 MILE RD
Second Line : DEPT OF NEONATOLOGY
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-465-3144
Fax Number : 248-465-3146
Provider Business Practice Location Address
First Line : 16001 W 9 MILE RD
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48075-4818
Country : US
Telephone Number : 248-849-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 11/18/2015

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