Provider Demographics
NPI:1528149283
Name:DERKIN, ELIZABETH R (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:R
Last Name:DERKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:607 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1663
Mailing Address - Country:US
Mailing Address - Phone:734-255-8223
Mailing Address - Fax:517-548-6326
Practice Address - Street 1:1221 BYRON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1069
Practice Address - Country:US
Practice Address - Phone:517-548-0010
Practice Address - Fax:517-548-5326
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704223149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner