Provider Demographics
NPI:1205553633
Name:HART, DANA RAE (NP-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RAE
Last Name:HART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6995 LAKESHORE RD N
Mailing Address - Street 2:
Mailing Address - City:PALMS
Mailing Address - State:MI
Mailing Address - Zip Code:48465-9635
Mailing Address - Country:US
Mailing Address - Phone:616-894-8081
Mailing Address - Fax:
Practice Address - Street 1:4675 HILL ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1099
Practice Address - Country:US
Practice Address - Phone:989-872-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily