Provider Demographics
NPI:1053127282
Name:PITTERS, EMMA ROSE (RN, BSN, FNP, MSN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:PITTERS
Suffix:
Gender:F
Credentials:RN, BSN, FNP, MSN
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ROSE
Other - Last Name:FOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:786 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1206
Mailing Address - Country:US
Mailing Address - Phone:313-919-3143
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704374650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily