Individual
MRS. ELIZABETH ABRAHAM KOYITHOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, PMHNP
Contact information
Practice address
1 FORD PL, HENRY FORD HOSPITAL, DETROIT, MI 48202-3450
(313) 874-4688
Mailing address
22192 HILLSIDE DR, NORTHVILLE, MI 48167-9146
(313) 952-1099
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
4704258693
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704258693
MI
Other
Enumeration date
05/31/2011
Last updated
03/30/2021
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