| NPI | 1780484998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICORYA SCOTT Provider 313-721-9699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2025-08-25 |