Individual
MARISA LICATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
21734 MALDEN ST, FARMINGTON HILLS, MI 48336-6041
(248) 229-0183
Mailing address
28050 GRAND RIVER AVE, FARMINGTON HILLS, MI 48336-5919
(248) 229-0183
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704303831
MI
Other
Enumeration date
09/24/2020
Last updated
04/07/2025
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