Healthcare Provider Details

I. General information

NPI: 1891351672
Provider Name (Legal Business Name): EMILY JEAN PUZAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 PINE ST
DECKERVILLE MI
48427-7703
US

IV. Provider business mailing address

3559 PINE ST
DECKERVILLE MI
48427-7703
US

V. Phone/Fax

Practice location:
  • Phone: 810-376-2835
  • Fax: 103-767-0208
Mailing address:
  • Phone: 810-376-2835
  • Fax: 103-767-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704313382
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704313382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: