Basic Information
| Provider Information | |||||||||
| NPI: | 1245658640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41943 HENSALL ST | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138121790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2799 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006536568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2014 | ||||||||
| LastUpdateDate: | 07/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 4704245138 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 363L00000X | 4704245138 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.