Individual
EMMA ELISE FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704374723
MI
363LG0600X
Gerontology Nurse Practitioner
2025063454
MI
Other
Enumeration date
02/17/2026
Last updated
03/30/2026
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