MEDICARE: CHARLI MARTHA FIELDS

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	163WI0500X	Infusion Therapy Registered Nurse	4704334299	MI
2	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	4704334299	MI
3	163W00000X	Registered Nurse	4704334299	MI

General Provider Information

NPI Number	:	1902753536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLI MARTHA FIELDS

Provider Business Mailing Address
First Line	:	17324 WASHBURN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 W. OUTER DRIVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219
Country	:	US
Telephone Number	:	734-363-7307
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ CHARLI MARTHA FIELDS ” Practice Location

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