1639550346 NPI number — MR. JOSEPH DARWIYN ENOS MSN, FNP B-C

Table of content: MR. JOSEPH DARWIYN ENOS MSN, FNP B-C (NPI 1639550346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639550346 NPI number — MR. JOSEPH DARWIYN ENOS MSN, FNP B-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENOS
Provider First Name:
JOSEPH
Provider Middle Name:
DARWIYN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP B-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENOS
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, FNP B-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639550346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1560 E MAPLE RD
Provider Second Line Business Mailing Address:
SUITE 400-CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-745-4525
Provider Business Mailing Address Fax Number:
313-577-3223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 CHRYSLER DR
Provider Second Line Business Practice Location Address:
STE 4A
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-4525
Provider Business Practice Location Address Fax Number:
313-577-3223
Provider Enumeration Date:
06/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704266426 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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