Provider Demographics
NPI:1306394580
Name:FODOR, ELISE DANIELLE (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:DANIELLE
Last Name:FODOR
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:DANIELLE
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1535 FOUNTAIN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6701
Mailing Address - Country:US
Mailing Address - Phone:248-202-3599
Mailing Address - Fax:
Practice Address - Street 1:909 W MAPLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1000
Practice Address - Country:US
Practice Address - Phone:248-280-1867
Practice Address - Fax:248-280-0222
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily