Healthcare Provider Details

I. General information

NPI: 1679117402
Provider Name (Legal Business Name): HANNAH JOY DEJONG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 RAMBLEWOOD DR
EAST LANSING MI
48823-6384
US

IV. Provider business mailing address

2175 COOLIDGE RD
EAST LANSING MI
48823-1379
US

V. Phone/Fax

Practice location:
  • Phone: 517-827-1800
  • Fax: 517-827-1805
Mailing address:
  • Phone: 517-827-1800
  • Fax: 517-827-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704321431
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: