Provider Demographics
NPI:1467217273
Name:PRIMARY CARE PLUS, PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE PLUS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:SHEVELL
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-522-0311
Mailing Address - Street 1:PO BOX 85367
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-0367
Mailing Address - Country:US
Mailing Address - Phone:313-522-0311
Mailing Address - Fax:
Practice Address - Street 1:38900 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3239
Practice Address - Country:US
Practice Address - Phone:313-522-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty