Individual
MARILYN NAH NGUNDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP -C, PMHNP-BC
Contact information
Practice address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 921-4700
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 921-4700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704312977
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704312977
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704312977
MI STATE LICENSE
MI
Enumeration date
11/30/2018
Last updated
02/03/2026
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