Provider Demographics
NPI:1487178174
Name:YOUSIF, AMY AMIRA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:AMIRA
Last Name:YOUSIF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39281 TWENLOW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5706
Mailing Address - Country:US
Mailing Address - Phone:248-912-5091
Mailing Address - Fax:
Practice Address - Street 1:6501 EAST 11 MILE RD BLDG 230, RM 134W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48397-3852
Practice Address - Country:US
Practice Address - Phone:586-282-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily