Provider Demographics
NPI:1922486729
Name:AREVALO, ANNE MARIE FANO (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:FANO
Last Name:AREVALO
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
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Mailing Address - Street 1:44725 GRAND RIVER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1024
Mailing Address - Country:US
Mailing Address - Phone:517-882-3732
Mailing Address - Fax:517-882-3633
Practice Address - Street 1:44725 GRAND RIVER AVE STE 104
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1024
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704274016363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse