Provider Demographics
NPI:1770234056
Name:PAPUSHA, IRINA (AGPC-C)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:PAPUSHA
Suffix:
Gender:F
Credentials:AGPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 W 13 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2172
Mailing Address - Country:US
Mailing Address - Phone:248-509-4070
Mailing Address - Fax:248-509-4080
Practice Address - Street 1:31500 W 13 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2172
Practice Address - Country:US
Practice Address - Phone:248-509-4070
Practice Address - Fax:248-509-4080
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG12210043363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology