Provider Demographics
NPI:1023055019
Name:BINNS-EMERICK, LISA (CNP, GCNS-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BINNS-EMERICK
Suffix:
Gender:F
Credentials:CNP, GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-1741
Mailing Address - Fax:313-745-8165
Practice Address - Street 1:4201 ST ANTOINE STE 5B
Practice Address - Street 2:DRH ROSA PARKS WELLNESS INSTITUTE FOR SR HEALTH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1741
Practice Address - Fax:313-745-8165
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704153550363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP32180016OtherMEDICARE PTAN#
MI0866595OtherBCBSM PROVIDER#
MIP32180016OtherMEDICARE PTAN#