Provider Demographics
NPI:1417303355
Name:BLAKEY, DEQUINDRA ELISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEQUINDRA
Middle Name:ELISE
Last Name:BLAKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:DEQUINDRA
Other - Middle Name:ELISE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:17723 E. WARREN
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2419
Mailing Address - Country:US
Mailing Address - Phone:734-489-9863
Mailing Address - Fax:202-470-6596
Practice Address - Street 1:17723 E. WARREN
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2419
Practice Address - Country:US
Practice Address - Phone:734-489-9863
Practice Address - Fax:202-470-6596
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily