Healthcare Provider Details

I. General information

NPI: 1952758476
Provider Name (Legal Business Name): DIANE YIRENKYI-GEORGE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE MATTE YIRENKYI-GEORGE NP-C

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28535 EVERGREEN RD
SOUTHFIELD MI
48076-5431
US

IV. Provider business mailing address

28535 EVERGREEN RD
SOUTHFIELD MI
48076-5431
US

V. Phone/Fax

Practice location:
  • Phone: 313-289-4392
  • Fax:
Mailing address:
  • Phone: 313-289-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704272459
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: