Provider Demographics
NPI:1629596788
Name:VISNER, CARMEN (NP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:VISNER
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 1:75 BARCLAY CIR STE 230
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5823
Mailing Address - Country:US
Mailing Address - Phone:248-246-1127
Mailing Address - Fax:248-246-0704
Practice Address - Street 1:75 BARCLAY CIR STE 230
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5823
Practice Address - Country:US
Practice Address - Phone:248-246-1127
Practice Address - Fax:248-246-0704
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner