Provider Demographics
NPI:1851193726
Name:ISSA, REEM (NP)
Entity type:Individual
Prefix:
First Name:REEM
Middle Name:
Last Name:ISSA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 MEADOWLANE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1170
Mailing Address - Country:US
Mailing Address - Phone:313-938-9242
Mailing Address - Fax:
Practice Address - Street 1:23000 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48134-9265
Practice Address - Country:US
Practice Address - Phone:734-304-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty