Individual
GRACE LUISE TAKISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
11012 E 13 MILE RD STE 112, WARREN, MI 48093-2546
(586) 573-6880
Mailing address
PO BOX 44897, DETROIT, MI 48244-0897
(734) 604-1873
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704318984
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06376
BCBSM
—
05
—
381958736
—
MI
Enumeration date
08/08/2024
Last updated
04/17/2025
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