Provider Demographics
NPI:1770981037
Name:DENNIS, AIMEE (NP, AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:NP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:#100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-435-3666
Mailing Address - Fax:562-276-4825
Practice Address - Street 1:880 W LONG LAKE RD # 600
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-4504
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-276-4825
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL556999363LG0600X, 363LP2300X
MI4704215131363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care