MEDICARE: DEANNA JEAN KAUFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704310906	MI

General Provider Information

NPI Number	:	1811866940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA JEAN KAUFMAN

Provider Business Mailing Address
First Line	:	4208 VINE ST
Second Line	:
City	:	SAINT CLAIR
State	:	MI
Zip	:	48079-4761
Country	:	US
Telephone Number	:	810-300-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	4208 VINE ST
Second Line	:
City	:	SAINT CLAIR
State	:	MI
Zip	:	48079-4761
Country	:	US
Telephone Number	:	810-300-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	11/05/2025

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