Healthcare Provider Details

I. General information

NPI: 1013931054
Provider Name (Legal Business Name): DENISE KERR RN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD CATH LAB
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

25925 TELEGRAPH RD #210
SOUTHFIELD MI
48034-2518
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3924
  • Fax: 248-849-2717
Mailing address:
  • Phone: 248-746-3218
  • Fax: 248-746-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number4704141108
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704141108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: