Provider Demographics
NPI:1669547774
Name:HENRY FORD HEALTH SYSTEM
Entity type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP MSN APRN-C
Authorized Official - Phone:734-523-8657
Mailing Address - Street 1:8967 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4143
Mailing Address - Country:US
Mailing Address - Phone:734-523-8657
Mailing Address - Fax:734-523-8667
Practice Address - Street 1:29200 SCHOOLCRAFT RD
Practice Address - Street 2:OFFICE 2264
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2228
Practice Address - Country:US
Practice Address - Phone:734-523-8657
Practice Address - Fax:734-523-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704113625363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty