Provider Demographics
NPI:1487749578
Name:NEUBAUER, DENISE J (DNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:J
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8035 MCDERMITT DR APT 123
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-3100
Mailing Address - Country:US
Mailing Address - Phone:810-516-3455
Mailing Address - Fax:
Practice Address - Street 1:4995 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1143
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:248-674-1027
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704162975363LF0000X
MIPRACTITIONER 4704162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34780030Medicare PIN