Provider Demographics
NPI:1811254956
Name:EMBURY, NANETTE (NP)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:
Last Name:EMBURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-817-7587
Mailing Address - Fax:517-817-7598
Practice Address - Street 1:1201 E MICHIGAN AVE
Practice Address - Street 2:STE 120
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1852
Practice Address - Country:US
Practice Address - Phone:517-817-7587
Practice Address - Fax:517-817-7598
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2021-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704135825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner