Healthcare Provider Details

I. General information

NPI: 1730063710
Provider Name (Legal Business Name): MR. EMEKA PASCHAL DURUNNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13202 IRVINGTON DR
WARREN MI
48088-4761
US

IV. Provider business mailing address

13202 IRVINGTON DR
WARREN MI
48088-4761
US

V. Phone/Fax

Practice location:
  • Phone: 502-558-7563
  • Fax:
Mailing address:
  • Phone: 502-558-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number4704362739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: