| Organization Name: | PRISM HEALTH CARE, PLC |
| NPI Number: | 1306266614 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYNETTE GUSS (NURSE PRACTITIONER) |
| Mailing Address: | 18211 W 12 Mile Rd Suite 2se Lathrup Village |
| State: | MI US |
| Postal Code: | 480762641 |
| Phone Number: | 2486772410 |
| Fax Number: | 2486672412 |
| NPI Enumeration Date: | 04/25/2014 |
| NPI Last Update Date: | 05/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704218575 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |