Provider Demographics
NPI:1780484998
Name:MOTOR CITY DRIP HYDRATION AND WELLNESS
Entity type:Organization
Organization Name:MOTOR CITY DRIP HYDRATION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
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:313-721-9699
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:313-969-7292
Mailing Address - Fax:313-731-0144
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:313-969-7292
Practice Address - Fax:313-731-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center