Provider Demographics
NPI:1043726144
Name:NP PROVISION, LLC
Entity type:Organization
Organization Name:NP PROVISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIMIKO
Authorized Official - Middle Name:L
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:313-587-3087
Mailing Address - Street 1:220 MAIN SAIL CT
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5008
Mailing Address - Country:US
Mailing Address - Phone:313-587-3087
Mailing Address - Fax:248-286-6255
Practice Address - Street 1:27177 LAHSER RD STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8468
Practice Address - Country:US
Practice Address - Phone:248-895-8562
Practice Address - Fax:248-286-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177492363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty