Provider Demographics
NPI:1811613268
Name:YERGENSON, CATHERINE ANN (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:YERGENSON
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 1:32458 HEES ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3721
Mailing Address - Country:US
Mailing Address - Phone:734-447-7386
Mailing Address - Fax:
Practice Address - Street 1:607 SHELBY ST STE 770-1356
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3268
Practice Address - Country:US
Practice Address - Phone:815-846-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704349530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily