Provider Demographics
NPI:1114561479
Name:HOWELL, ELENA MARIE
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 W MAPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3118
Mailing Address - Country:US
Mailing Address - Phone:248-885-8211
Mailing Address - Fax:
Practice Address - Street 1:20490 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48167-3955
Practice Address - Country:US
Practice Address - Phone:734-956-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily