Provider Demographics
NPI:1770350308
Name:NABOZNY, MICHELLE TERESE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TERESE
Last Name:NABOZNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29510 FOUNTAIN BLVD APT 1101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5809
Mailing Address - Country:US
Mailing Address - Phone:734-612-9041
Mailing Address - Fax:
Practice Address - Street 1:29510 FOUNTAIN BLVD APT 1101
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5809
Practice Address - Country:US
Practice Address - Phone:734-612-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)