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Individual

MRS. SCARLETT IDEMA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
8631 W VERNOR HWY STE 1A, DETROIT, MI 48209-3420
(313) 889-2000
(313) 889-3000
Mailing address
8631 W VERNOR HWY STE 1A, DETROIT, MI 48209-3420
(313) 889-2000
(313) 889-3000

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4704325475
MI
363LF0000X
Family Nurse Practitioner
Primary
4704325475
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1316520653
MI
05
4704325475
MI
Enumeration date
05/04/2021
Last updated
02/01/2026
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