Provider Demographics
NPI:1235870007
Name:BROZE, INGRID (PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:INGRID
Middle Name:
Last Name:BROZE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 CASTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-1759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28580 ORCHARD LAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2988
Practice Address - Country:US
Practice Address - Phone:248-865-7271
Practice Address - Fax:248-865-7274
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0035674363LP0808X
MI4704381868363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health