Healthcare Provider Details

I. General information

NPI: 1689555278
Provider Name (Legal Business Name): JULIE MAE DENNIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N CLIPPERT ST
LANSING MI
48912-4701
US

IV. Provider business mailing address

1443 KNAPP ST NE
GRAND RAPIDS MI
49505-4447
US

V. Phone/Fax

Practice location:
  • Phone: 517-999-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: