Individual
LISA NICOLE YAXLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3555 W 13 MILE RD STE N120, ROYAL OAK, MI 48073-6710
(248) 551-1701
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1867
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704299631
MI
Other
Enumeration date
02/06/2017
Last updated
09/30/2019
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