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NPI Code Detail

MEDICARE: MRS. BILLIE-ANN BLACK DNP

MEDICARE: MRS. BILLIE-ANN BLACK DNP
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
1363LF0000XFamily Nurse Practitioner71001186AIN

General Provider Information

NPI Number : 1508837782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BILLIE-ANN BLACK DNP
Provider Business Mailing Address
First Line : PO BOX 781076
Second Line :
City : DETROIT
State : MI
Zip : 48278-1076
Country : US
Telephone Number : 317-528-4800
Fax Number :
Provider Business Practice Location Address
First Line : 4111 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-7803
Country : US
Telephone Number : 219-873-2919
Fax Number : 219-873-2909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 10/22/2024

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