Individual
MRS. SANDRA L ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
39350 9 MILE RD, NORTHVILLE, MI 48167-9164
(248) 425-5149
Mailing address
3719 HI DALE DR, LAKE ORION, MI 48360-2422
(248) 391-0114
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704077181
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4476822
—
MI
Enumeration date
08/10/2005
Last updated
01/20/2009
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