Provider Demographics
NPI:1821178518
Name:DAVISSON, AMY ABDELNOUR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ABDELNOUR
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:ABDELNOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15119 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2907
Mailing Address - Country:US
Mailing Address - Phone:313-865-2020
Mailing Address - Fax:
Practice Address - Street 1:15119 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2907
Practice Address - Country:US
Practice Address - Phone:313-865-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004912363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant