Healthcare Provider Details

I. General information

NPI: 1891032009
Provider Name (Legal Business Name): EUN JU YEON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41850 W 11 MILE RD # 109
NOVI MI
48375-1819
US

IV. Provider business mailing address

26721 KENTUCKY CT
SOUTH LYON MI
48178-8221
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-1220
  • Fax:
Mailing address:
  • Phone: 734-756-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704318215
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704318215
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: