Organization
IMAN NP CENTER LLC
Active
Other names
Iman Nurse Practitioner Center
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA SHIVACHI-WILLIAMS NP-C (NURSE PRACTITIONER)
(248) 595-8536
Entity
Organization
Contact information
Practice address
26771 W 12 MILE RD, SUITE 101, SOUTHFIELD, MI 48034-1539
(248) 595-8536
(248) 809-2043
Mailing address
26771 W 12 MILE RD, SUITE 101, SOUTHFIELD, MI 48034-1539
(248) 595-8536
(248) 809-2043
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
MI
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008616330
BCBS/BCN
MI
Enumeration date
03/21/2012
Last updated
08/06/2012
Update your record
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