Provider Demographics
NPI:1598470189
Name:SAN SOUCI, ILANA SAMANTHA (DNP, FNP-C, BSN, RN)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:SAMANTHA
Last Name:SAN SOUCI
Suffix:
Gender:F
Credentials:DNP, FNP-C, BSN, RN
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Other - Middle Name:
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR # J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:19000 ST JOES PKWY STE 140
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1477
Practice Address - Country:US
Practice Address - Phone:734-213-3688
Practice Address - Fax:734-213-3687
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704330052163W00000X, 363L00000X
OH470855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse