DAJUAN FANNING NPI 1376102434

NPI Information

NPI: 1376102434
Provider Name: DAJUAN FANNING
Classification: Licensed Practical Nurse - 164W00000X
Entity Type: Individual
Address:
17072 NEW HAMPSHIRE DR
SOUTHFIELD, MI
ZIP 48075
Phone: (313) 213-7470
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Dajuan Fanning is a licensed practical nurse in Southfield, MI. The provider is a licensed practical nurse 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. Dajuan Fanning NPI is 1376102434. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

17072 NEW HAMPSHIRE DR
SOUTHFIELD, MI
ZIP 48075-972
Phone: (313) 213-7470

The enumeration date for this NPI number is 6/11/2019 and was last updated on 6/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	372500000X	Chore Provider			No
2	374U00000X	Home Health Aide			No
3	405300000X	Prevention Professional	4703116420	MICHIGAN	No
4	164W00000X	Licensed Practical Nurse	4703116420	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	4703116420	OTHER	MICHIGAN	BCBS
2	4703116420	MEDICAID	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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