Individual
CIENNA RENEE LODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(313) 938-1442
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704338438
MI
363LG0600X
Gerontology Nurse Practitioner
4704338438
MI
Other
Enumeration date
10/05/2022
Last updated
08/11/2025
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