Provider Demographics
NPI:1164183307
Name:VANNOSTRAND, FELICIA MICHELE (BSN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:MICHELE
Last Name:VANNOSTRAND
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21406 COLWELL ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-6117
Mailing Address - Country:US
Mailing Address - Phone:313-384-1398
Mailing Address - Fax:
Practice Address - Street 1:24502 W 7 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1611
Practice Address - Country:US
Practice Address - Phone:877-709-9387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311632163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse