Provider Demographics
NPI:1639675473
Name:MANSFIELD, JUSTON N (NP-C)
Entity Type:Individual
Prefix:
First Name:JUSTON
Middle Name:N
Last Name:MANSFIELD
Suffix:
Gender:M
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 1:1546 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1648
Mailing Address - Country:US
Mailing Address - Phone:248-721-7388
Mailing Address - Fax:313-543-6233
Practice Address - Street 1:10300 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2100
Practice Address - Country:US
Practice Address - Phone:248-398-3200
Practice Address - Fax:248-398-3200
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283237NSA18453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily