Provider Demographics
NPI:1114105426
Name:POMEROY, GILBERT WAYNE (NP)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:WAYNE
Last Name:POMEROY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1018
Mailing Address - Country:US
Mailing Address - Phone:734-309-0307
Mailing Address - Fax:
Practice Address - Street 1:27600 FARMINGTON RD STE 107
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3364
Practice Address - Country:US
Practice Address - Phone:313-724-3111
Practice Address - Fax:248-294-1174
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156269163WP0809X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult