Individual
ERICA MICHELLE FOVENESI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4466 W BRISTOL RD, FLINT, MI 48507-3170
(810) 733-1200
(810) 733-0688
Mailing address
4466 W BRISTOL RD, FLINT, MI 48507-3170
(810) 733-1200
(810) 733-0688
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007093
MI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841692373
—
MI
01
—
5250505
BCBSM
MI
Enumeration date
09/16/2014
Last updated
01/07/2022
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