Provider Demographics
NPI:1922660521
Name:RODWELL, ESMAHAN (RN)
Entity Type:Individual
Prefix:
First Name:ESMAHAN
Middle Name:
Last Name:RODWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ESMAHAN
Other - Middle Name:
Other - Last Name:RODWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:643 KARMADA ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1207
Mailing Address - Country:US
Mailing Address - Phone:734-660-2062
Mailing Address - Fax:
Practice Address - Street 1:882 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3710
Practice Address - Country:US
Practice Address - Phone:313-982-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse