Provider Demographics
NPI:1083900591
Name:MANTEUFFEL, MARIE ELIZABETH (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:MANTEUFFEL
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Gender:F
Credentials:RN, MSN, FNP-C
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Mailing Address - Street 1:1 FORD PL STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:800-653-6568
Mailing Address - Fax:313-876-1305
Practice Address - Street 1:16258 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1401
Practice Address - Country:US
Practice Address - Phone:734-250-9062
Practice Address - Fax:734-250-9072
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704263976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily