MEDICARE: MARY LOUISE SEVERIN RN

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	163WP0200X	Pediatric Registered Nurse	470410293	MI

General Provider Information

NPI Number	:	1871391540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LOUISE SEVERIN RN

Provider Business Mailing Address
First Line	:	8865 ARGONNE
Second Line	:
City	:	GREGORY
State	:	MI
Zip	:	48137-9650
Country	:	US
Telephone Number	:	734-417-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 W LIBERTY RD STE A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9794
Country	:	US
Telephone Number	:	734-417-5233
Fax Number	:	734-994-4322

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

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	03/06/2025

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