Provider Demographics
NPI:1043201288
Name:KLENK, DOROTA MELLER (RN NP)
Entity Type:Individual
Prefix:MRS
First Name:DOROTA
Middle Name:MELLER
Last Name:KLENK
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:MELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP
Mailing Address - Street 1:6777 W. MAPLE RD
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6777 W. MAPLE RD
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-910-0061
Practice Address - Fax:248-849-3230
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner