Provider Demographics
NPI:1417606088
Name:DEHAAN, KATERINA
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:DEHAAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22201 MOROSS RD STE 370
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2176
Mailing Address - Country:US
Mailing Address - Phone:313-343-4585
Mailing Address - Fax:313-343-7126
Practice Address - Street 1:22201 MOROSS RD STE 370
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2176
Practice Address - Country:US
Practice Address - Phone:313-343-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program