Individual provider Active NPI

Tracy Bosanko, PMHNP

  • Adult Psychiatric/Mental Health Registered Nurse
  • Livonia, MI
National Provider Identifier
1184445264
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X
License
4704329968 Issued in MI
Practice address
17177 N Laurel Park Dr Ste 131
Livonia, MI 48152-3952
Phone
(734) 462-3210
Fax
(734) 462-1024
NPI assigned
Oct 21, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X 4704329968 MI Primary

Addresses

Primary practice location

17177 N Laurel Park Dr Ste 131
Livonia, MI 48152-3952

Mailing address

5842 Hathaway Rd
Canton, MI 48187-5609
Phone (734) 536-3043

Other practice location 1

5842 Hathaway Rd
Canton, MI 48187-5609
Phone (734) 536-3043

Other names 1

  • Tracy Schleif Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250122002742 MI Practitioner - Nurse Practitioner 3971032806 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Victor M. Cruz MD, P.C.Group PAC ID 3375604952, 29 clinicians

Practice addresses (Care Compare)

17177 N Laurel Park Dr
Suite 131
Livonia, MI 48152-3952
Phone (734) 462-3210

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704329968MIMDAdult Psychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Victor M. Cruz MD, P.C. CurrentSince Jan 2, 2025 Accepting new patients

Locations

17177 Laurel Dr
Ste 131
Livonia, MI 48152
Phone (313) 462-3210

17177 N Laurel Park Dr
Ste 131
Livonia, MI 48152
Phone (734) 462-3210

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1184445264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5842 HATHAWAY RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875609",
            "telephone_number": "734-536-3043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17177 N LAUREL PARK DR STE 131",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481523952",
            "telephone_number": "734-462-3210",
            "fax_number": "734-462-1024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5842 Hathaway Rd",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481875609",
            "country_code": "US",
            "telephone_number": "734-536-3043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSANKO",
        "first_name": "TRACY",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-21",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MI",
            "license": "4704329968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "SCHLEIF",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Livonia, MI

Sources for this page

Verify at the official NPI Registry.