Provider Demographics
NPI:1396852265
Name:DOUTE, DARLENE ANN (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:ANN
Last Name:DOUTE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4664
Mailing Address - Country:US
Mailing Address - Phone:248-668-8650
Mailing Address - Fax:248-668-8651
Practice Address - Street 1:41100 FOX RUN
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-4804
Practice Address - Country:US
Practice Address - Phone:248-668-8650
Practice Address - Fax:248-668-8651
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126904363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396852265Medicaid
8305187OtherEVERCARE
5008663690OtherBCBS OF MI
P00695862Medicare PIN
MI1396852265Medicaid