Provider Demographics
NPI:1215585005
Name:SERVITO, DANIEL (FNP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SERVITO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SOUTH BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3163
Mailing Address - Country:US
Mailing Address - Phone:248-206-1200
Mailing Address - Fax:248-206-1206
Practice Address - Street 1:585 SOUTH BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3163
Practice Address - Country:US
Practice Address - Phone:248-206-1200
Practice Address - Fax:248-206-1206
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704302514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily