Provider Demographics
NPI:1932147485
Name:CLINTON, DENISE J (FNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:J
Last Name:CLINTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35429 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4258
Mailing Address - Country:US
Mailing Address - Phone:586-264-4261
Mailing Address - Fax:586-264-4707
Practice Address - Street 1:35429 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4258
Practice Address - Country:US
Practice Address - Phone:586-264-4261
Practice Address - Fax:586-264-4707
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008603900OtherBCBSM PROVIDER PIN
MI4643662Medicaid
MI4643662Medicaid