Provider Demographics
NPI:1790199313
Name:PARADISE-BUMHOFFER, LAUREL ANNE (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANNE
Last Name:PARADISE-BUMHOFFER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ANNE
Other - Last Name:PARADISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:3807 NORTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506
Practice Address - Country:US
Practice Address - Phone:810-736-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224208363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily