=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992503387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUKE ADVANCED HEALTHCARE STAFFING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 S AIRPORT RD
-----------------------------------------------------
City | SAINT IGNACE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49781-1049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-984-2030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25068 COUNTY ROAD 98
-----------------------------------------------------
City | MC MILLAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49853-9369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-255-7082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NURSE PRACTITIONER
-----------------------------------------------------
Name | ROBERT STANLEY DUKE
-----------------------------------------------------
Credential | FNP-BC
-----------------------------------------------------
Telephone | 586-255-7082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------