Provider Demographics
NPI:1790335263
Name:PRICE, ESHA (NP)
Entity Type:Individual
Prefix:
First Name:ESHA
Middle Name:
Last Name:PRICE
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 1:12048 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-1836
Mailing Address - Country:US
Mailing Address - Phone:313-635-5978
Mailing Address - Fax:313-635-5978
Practice Address - Street 1:12048 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-1836
Practice Address - Country:US
Practice Address - Phone:313-635-5978
Practice Address - Fax:313-635-2171
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704236121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily