Provider Demographics
NPI:1356858013
Name:USEN, IFIOK NSIMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:IFIOK
Middle Name:NSIMA
Last Name:USEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2792 TALL TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-3844
Mailing Address - Country:US
Mailing Address - Phone:313-610-5482
Mailing Address - Fax:248-714-9463
Practice Address - Street 1:2792 TALL TIMBERS DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48380-3844
Practice Address - Country:US
Practice Address - Phone:313-610-5482
Practice Address - Fax:248-714-9463
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner