MEDICARE: MRS. ALMETA M ANDARY FNP

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
1	363LF0000X	Family Nurse Practitioner	4704261320	MI

General Provider Information

NPI Number	:	1477987188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALMETA M ANDARY FNP

Provider Business Mailing Address
First Line	:	22341 WEST EIGHT MILE RD
Second Line	:	SUITE #4
City	:	DETROIT
State	:	MI
Zip	:	48219
Country	:	US
Telephone Number	:	313-421-6643
Fax Number	:	313-372-5509

Provider Business Practice Location Address
First Line	:	11180 GRATIOT AVE
Second Line	:	SUITE C
City	:	DETROIT
State	:	MI
Zip	:	48213-1363
Country	:	US
Telephone Number	:	313-372-7111
Fax Number	:	313-372-5509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/28/2023

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