Provider Demographics
NPI:1437632437
Name:DERKS, CLAIRE MARIE J (LMT, RN)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE MARIE
Middle Name:J
Last Name:DERKS
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:CLAIRE MARIE
Other - Middle Name:J
Other - Last Name:STEINBERG-DERKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN-RN
Mailing Address - Street 1:119 NORTH STONE ROAD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412
Mailing Address - Country:US
Mailing Address - Phone:231-924-2590
Mailing Address - Fax:231-924-6560
Practice Address - Street 1:119 NORTH STONE ROAD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412
Practice Address - Country:US
Practice Address - Phone:231-924-2590
Practice Address - Fax:231-924-6560
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011030225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist