Individual provider · Type 1 NPI
Marisa Licata, NP
Family Nurse Practitioner · Farmington Hills, MI
NPI number
1790392603
Active
Practice location
21734 Malden St
Farmington Hills, MI 48336-6041
Mailing address
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 4704303831 (MI) |
Family Nurse Practitioner: Definition to come...
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About NPI 1790392603
Marisa Licata, NP's National Provider Identifier is 1790392603, issued on Sep 24, 2020. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Farmington Hills, MI. The record was last updated on Apr 7, 2025.