Individual
ANN MARCELLE PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
43740 N GROESBECK HWY, CLINTON TOWNSHIP, MI 48036-1139
(586) 469-7629
Mailing address
665 CUMBERLAND ST, MOUNT CLEMENS, MI 48043-2924
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704155196
MI
163WC0400X
Case Management Registered Nurse
Primary
4704155196
MI
163WC1500X
Community Health Registered Nurse
4704155196
MI
163WP0808X
Psychiatric/Mental Health Registered Nurse
4704155196
MI
Other
Enumeration date
02/27/2007
Last updated
09/11/2025
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