Individual
TRACY BOSANKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
17177 N LAUREL PARK DR STE 131, LIVONIA, MI 48152-3952
(734) 462-3210
(734) 462-1024
Mailing address
5842 HATHAWAY RD, CANTON, MI 48187-5609
(734) 536-3043
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
4704329968
MI
Other
Enumeration date
10/21/2024
Last updated
06/06/2025
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