Provider Demographics
NPI:1851932446
Name:PARRISH, ADINA DERECICHEI (FNP)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:DERECICHEI
Last Name:PARRISH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 BERNIE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3483
Mailing Address - Country:US
Mailing Address - Phone:248-217-7678
Mailing Address - Fax:
Practice Address - Street 1:22255 GREENFIELD RD STE 422
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3730
Practice Address - Country:US
Practice Address - Phone:248-849-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704293368OtherFNP LICENSE NUMBER