Provider Demographics
NPI:1093107948
Name:KING, DENIENE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:DENIENE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 GREENFIELD RD
Mailing Address - Street 2:#203
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5237
Mailing Address - Country:US
Mailing Address - Phone:248-968-1550
Mailing Address - Fax:
Practice Address - Street 1:23300 GREENFIELD RD
Practice Address - Street 2:#203
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-5237
Practice Address - Country:US
Practice Address - Phone:248-968-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG0215066363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology