MEDICARE: MRS. CATHERINE THERESE ENSWORTH AGNP-C, PMHNP-BC

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	363L00000X	Nurse Practitioner	4704196169	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704196169	MI

General Provider Information

NPI Number	:	1629687785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE THERESE ENSWORTH AGNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	50721 PINNACLE WOODS LN
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-5535
Country	:	US
Telephone Number	:	586-484-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 S SAGINAW ST STE 1900
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2677
Country	:	US
Telephone Number	:	586-484-8699
Fax Number	:

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

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/27/2022

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