Healthcare Provider Details

I. General information

NPI: 1487195566
Provider Name (Legal Business Name): VERNA RENEE DUBORD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44200 WOODWARD AVE SUITE 209
PONTIAC MI
48341-5045
US

IV. Provider business mailing address

1886 W AUBURN RD SUITE 400
ROCHESTER HILLS MI
48309-3865
US

V. Phone/Fax

Practice location:
  • Phone: 248-253-0330
  • Fax: 248-253-1982
Mailing address:
  • Phone: 248-290-3111
  • Fax: 248-290-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704185426
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704185426
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number4704185426
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704185426
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number4704185426
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number4704185426
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number4704185426
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number4704185426
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number4704185426
License Number StateMI
# 10
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704185426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: