Provider Demographics
NPI:1356156368
Name:MOTOR CITY DRIP HYDRATION AND WELLNESS LLC
Entity type:Organization
Organization Name:MOTOR CITY DRIP HYDRATION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICORYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:833-221-4169
Mailing Address - Street 1:21701 W 11 MILE RD STE 11
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3713
Mailing Address - Country:US
Mailing Address - Phone:833-221-4169
Mailing Address - Fax:
Practice Address - Street 1:21701 W 11 MILE RD STE 11
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3713
Practice Address - Country:US
Practice Address - Phone:833-221-4169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty