Healthcare Provider Details

I. General information

NPI: 1639046675
Provider Name (Legal Business Name): DELOES GOINES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 S LINDEN RD
FLINT MI
48532-5483
US

IV. Provider business mailing address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-2913
  • Fax: 734-222-7499
Mailing address:
  • Phone: 810-720-2913
  • Fax: 734-222-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704284673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: