Provider Demographics
NPI:1457152217
Name:DUCASTEL, JEREMY NICKOLAS (NP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:NICKOLAS
Last Name:DUCASTEL
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 LEGACY PKWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4265
Mailing Address - Country:US
Mailing Address - Phone:844-565-0694
Mailing Address - Fax:517-882-3633
Practice Address - Street 1:4136 LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4265
Practice Address - Country:US
Practice Address - Phone:844-565-0694
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2025002159363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health