Provider Demographics
NPI:1457058273
Name:PREDUCAJ, DESARA (DNP, RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:DESARA
Middle Name:
Last Name:PREDUCAJ
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:DESARA
Other - Middle Name:
Other - Last Name:ULDEDAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, RN, FNP-BC
Mailing Address - Street 1:35284 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35284 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2096
Practice Address - Country:US
Practice Address - Phone:586-335-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704351329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2022090598OtherANCC