Individual
LISA PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
359 ENTERPRISE CT SPC B, BLOOMFIELD HILLS, MI 48302-1055
(248) 751-7246
(248) 418-2311
Mailing address
359 ENTERPRISE CT SPC B, BLOOMFIELD HILLS, MI 48302-1055
(248) 751-7246
(248) 418-2311
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704150069
MI
Other
Enumeration date
01/03/2008
Last updated
05/23/2023
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