Provider Demographics
NPI:1306394580
Name:FODOR, ELISE DANIELLE (MSN, RN, FNP-C)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:DANIELLE
Last Name:FODOR
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:DANIELLE
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4230 LOU MAR LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1905
Mailing Address - Country:US
Mailing Address - Phone:248-202-3599
Mailing Address - Fax:
Practice Address - Street 1:1380 COOLIDGE HWY STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7067
Practice Address - Country:US
Practice Address - Phone:248-280-1867
Practice Address - Fax:248-280-0222
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily