Provider Demographics
NPI:1447813092
Name:CONCEPCION, VIOLETTE ABELLERA
Entity type:Individual
Prefix:
First Name:VIOLETTE
Middle Name:ABELLERA
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39487 DORCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5017
Mailing Address - Country:US
Mailing Address - Phone:734-272-3444
Mailing Address - Fax:
Practice Address - Street 1:17515 W 9 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4404
Practice Address - Country:US
Practice Address - Phone:248-967-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner