Provider Demographics
NPI:1639794894
Name:MEIER, COREY DOUGLAS (FNP-BC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:DOUGLAS
Last Name:MEIER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 CONESTOGA DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1227
Mailing Address - Country:US
Mailing Address - Phone:810-931-1967
Mailing Address - Fax:
Practice Address - Street 1:6020 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2335
Practice Address - Country:US
Practice Address - Phone:810-407-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292895NSA200BG363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily