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NPI Code Detail

MEDICARE: MRS. MAUREEN ANN VANTINE ANP

MEDICARE: MRS. MAUREEN ANN VANTINE ANP
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
1363LA2200XAdult Health Nurse PractitionerCNP4160MN
2363LA2200XAdult Health Nurse PractitionerCOA.11871-NPOH

General Provider Information

NPI Number : 1124337860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAUREEN ANN VANTINE ANP
Provider Business Mailing Address
First Line : 400 RENAISSANCE CTR STE 2600
Second Line :
City : DETROIT
State : MI
Zip : 48243-1599
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 400 RENAISSANCE CTR STE 2600
Second Line :
City : DETROIT
State : MI
Zip : 48243-1599
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2010
Last Update Date : 08/21/2025

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Directions to “ MRS. MAUREEN ANN VANTINE ANP” Practice Location

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