Individual
MS. ELYSE C VAN ITTERSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
4060 ROCHESTER RD, TROY, MI 48085-4923
(248) 250-6420
(248) 250-6430
Mailing address
6058 HEARTHSIDE DR, TROY, MI 48098-5363
(248) 765-6535
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704341270
MI
Other
Enumeration date
09/18/2020
Last updated
04/06/2023
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