MEDICARE: PAULINE KAY DEHLIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704244588	MI

General Provider Information

NPI Number	:	1376054957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE KAY DEHLIN FNP

Provider Business Mailing Address
First Line	:	331 LEXINGTON AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3650
Country	:	US
Telephone Number	:	517-488-4967
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 ASSOCIATION DR STE 100
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-6039
Country	:	US
Telephone Number	:	517-999-1104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	05/27/2026

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