Provider Demographics
NPI:1700327640
Name:SECOR, ROBERT (FNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SECOR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 S M 43 HWY
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-9415
Mailing Address - Country:US
Mailing Address - Phone:269-623-5521
Mailing Address - Fax:
Practice Address - Street 1:4301 HARRINGTON RD
Practice Address - Street 2:
Practice Address - City:DELTON
Practice Address - State:MI
Practice Address - Zip Code:49046-9568
Practice Address - Country:US
Practice Address - Phone:269-580-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704226211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily