Nurse Practitioner, Family
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Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1013756576 · enumerated 2024-05-23 · record updated 2025-03-06. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Addresses and phones
- Practice location 5758 COOLEY LAKE RD, WATERFORD, MI, 48327-3073 (855) 466-3631 Google Maps Apple Maps OpenStreetMap
- Mailing address 5758 COOLEY LAKE RD, WATERFORD, MI, 48327-3073 (855) 466-3631 Google Maps Apple Maps OpenStreetMap
Specialties
- Registered Nurse 163W00000X · License 4704247636 MI
- Nurse Practitioner, Family 363LF0000X · Primary · License 4704247636 MI
In this directory
Locations and evidence
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Practice location
WATERFORD, MI, 483273073
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.