Provider Demographics
NPI:1073018990
Name:MCCLEESE, JOY M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:MCCLEESE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 EAGLE LANDINGS CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3772
Mailing Address - Country:US
Mailing Address - Phone:248-895-9237
Mailing Address - Fax:
Practice Address - Street 1:123 S MAIN ST STE 260
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2636
Practice Address - Country:US
Practice Address - Phone:586-758-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-25
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner