Provider Demographics
NPI:1063931863
Name:EDDY, JOANNA (RN, BSN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:EDDY
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:KLEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29732 KEVIN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1422 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1437
Practice Address - Country:US
Practice Address - Phone:248-257-4016
Practice Address - Fax:248-693-3683
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704281614363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse