Provider Demographics
NPI:1154792794
Name:DELAURENTIIS, JOYCE LYNN (NP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LYNN
Last Name:DELAURENTIIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 EMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-4240
Mailing Address - Country:US
Mailing Address - Phone:313-506-4877
Mailing Address - Fax:
Practice Address - Street 1:1021 EMMONS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-4240
Practice Address - Country:US
Practice Address - Phone:313-506-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily