DAJUAN FANNING (NPI# 1376102434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376102434 |
| Entity Type | Individual |
| Full Name | DAJUAN FANNING |
| Practice Address |
17072 New Hampshire Dr Southfield MI 48075-2972 |
| Practice Telephone | 3132137470 |
| Mailing Telephone | 3132137470 |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | 4703116420 | MI | Nursing Service Providers |
| N | 372500000X | Chore Provider | Nursing Service Related Providers | ||
| N | 374U00000X | Home Health Aide | Nursing Service Related Providers | ||
| N | 405300000X | Prevention Professional | 4703116420 | MI | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS | 4703116420 | 01 |
| MI | 4703116420 | 05 |
| Street Address |
17072 NEW HAMPSHIRE DR |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-2972 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730789546 | Lashonda S Noble | Licensed Practical Nurse | 21107 Lahser Rd, Southfield, MI 48033-4400 | 2020-10-30 |
| 1558990432 | Lawanda D Gibson | Licensed Practical Nurse | 21415 Civic Center Dr Ste 302, Southfield, MI 48076-3954 | 2020-04-03 |
| 1306409404 | Rochelle L Smith | Licensed Practical Nurse | 26748 Franklin Pointe Dr, Southfield, MI 48034-5626 | 2019-04-16 |
| 1063972800 | Amicah Desiray Tolbert | Licensed Practical Nurse | 17608 Gateway Cir, Southfield, MI 48075-4718 | 2019-03-20 |
| 1396211884 | Carolyn Burroughs | Licensed Practical Nurse | 26962 Franklin Rd Apt 131, Southfield, MI 48033-2437 | 2018-10-23 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1558863308 | Taqayla Allie | Licensed Practical Nurse | 23870 Lawn Rd Apt 2104, Southfield, MI 48033-3138 | 2018-03-07 |
| 1003322637 | Crystal Young-rowe | Licensed Practical Nurse | 19800 Saxton Ave, Southfield, MI 48075-7330 | 2017-12-19 |
| 1851807440 | Jasmine Nelson | Licensed Practical Nurse | 25597 Ingleside Dr, Southfield, MI 48033-4842 | 2017-12-19 |
| 1811429244 | Sandra Dee Wolfe | Licensed Practical Nurse | 21271 8 1/2 Mile Rd, Southfield, MI 48075-3876 | 2017-04-03 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
Please comment or provide details below to improve the information on DAJUAN FANNING.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.