Provider Demographics
NPI:1891192654
Name:KLENK, ROXANNE (NP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:KLENK
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 1:286 S SHAW LN
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-9486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:286 S SHAW LN
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:MI
Practice Address - Zip Code:48634-9486
Practice Address - Country:US
Practice Address - Phone:989-239-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704166432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health