Healthcare Provider Details

I. General information

NPI: 1700345154
Provider Name (Legal Business Name): CHARNEIL DONYELL DUKES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 CAPITAL AVE SW STE 302
BATTLE CREEK MI
49015-4187
US

IV. Provider business mailing address

5301 RUSSELL ST
DETROIT MI
48211-2500
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6333
  • Fax: 269-979-6335
Mailing address:
  • Phone: 313-310-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704269527
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: