Provider Demographics
NPI:1770737066
Name:DHALIWAL, JOANNA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:MARIE
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7210 N MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1575
Mailing Address - Country:US
Mailing Address - Phone:248-625-0372
Mailing Address - Fax:248-625-0239
Practice Address - Street 1:7210 N MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1575
Practice Address - Country:US
Practice Address - Phone:248-625-0372
Practice Address - Fax:248-625-0239
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704239411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily