Individual
FATOUMATA MOUKIR NDUKWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
24450 EVERGREEN ROAD, 215, SOUTHFIELD, MI 48075-2022
(248) 996-8076
Mailing address
6581 FLORENCE LANE, BELLEVILLE, MI 48111
(313) 971-7363
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704267630
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704267630
STATE OF MICHIGAN
MI
Enumeration date
06/06/2018
Last updated
06/16/2018
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