MEDICARE: ALISHA DEMO

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	4704343043	MI

General Provider Information

NPI Number	:	1962108951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA DEMO

Provider Business Mailing Address
First Line	:	500 N OAK ST
Second Line	:
City	:	DURAND
State	:	MI
Zip	:	48429-1224
Country	:	US
Telephone Number	:	989-277-4579
Fax Number	:

Provider Business Practice Location Address
First Line	:	8911 N CAPITAL OF TEXAS HWY STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-7247
Country	:	US
Telephone Number	:	877-279-5960
Fax Number	:	877-384-3106

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	01/17/2025

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Directions to “ ALISHA DEMO ” Practice Location

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