Provider Demographics
NPI:1609853399
Name:SIX, DEE (NP)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:SIX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:6207 HARVEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7861
Practice Address - Country:US
Practice Address - Phone:231-672-2201
Practice Address - Fax:231-672-2231
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704176401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4745377Medicaid
MI4745377Medicaid
MI4745377Medicaid