Provider Demographics
NPI:1184449522
Name:HAKIM, DEENA (NP)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:HAKIM
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 1:305 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2729
Mailing Address - Country:US
Mailing Address - Phone:810-629-9200
Mailing Address - Fax:810-629-9653
Practice Address - Street 1:10984 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3058
Practice Address - Country:US
Practice Address - Phone:734-762-0798
Practice Address - Fax:734-762-6682
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704382217363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner