DANIEL FENDERSON (NPI# 1104390350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104390350 |
| Entity Type | Individual |
| Full Name | DANIEL FENDERSON |
| Credential | APRN, CNP |
| Practice Address |
15150 Fort St Southgate MI 48195-1302 |
| Practice Telephone | 7342824800 |
| Mailing Telephone | 7342824800 |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2019-01-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
APRN.CNP.023196 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704308778 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
15150 FORT ST |
| City | SOUTHGATE |
| State | MI |
| Zip Code | 48195-1302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699777995 | Mustafa A Hashem | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2005-06-01 |
| 1629693791 | Diana Bischer | Nurse Practitioner | 15150 Fort St, Southgate, MI 48195-1302 | 2020-06-14 |
| 1871957985 | Natisha Irene Clark | Registered Nurse | 15150 Fort St, Southgate, MI 48195-1302 | 2016-04-06 |
| 1871958744 | Saba Madhoun | Physician Assistant | 15150 Fort St, Southgate, MI 48195-1302 | 2015-12-21 |
| 1437415874 | Mashkur Husain | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2012-04-10 |
| 1396976080 | Ashraf Ehab Mostafa | Internal Medicine | 15150 Fort St, Southgate, MI 48195 | 2009-07-29 |
| 1225294168 | Qaiser Shafiq | Internal Medicine | 15150 Fort St, Southgate, MI 48195 | 2008-07-30 |
| 1568620003 | Nitin K. Gupta | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2008-05-31 |
| 1578767950 | Ameen A Abdulmalik | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2007-06-12 |
| 1598968547 | Abdulwahhab Alroaini | Internal Medicine | 15150 Fort St, Southgate, MI 48195-1302 | 2007-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780206656 | Destiny D Harris | Social Worker | 14799, Southgate, MI 48195 | 2020-05-13 |
| 1285102368 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 16256 Fort St, Southgate, MI 48195 | 2018-11-07 |
| 1003382979 | Saran Charisse Watts | Case Manager/Care Coordinator | 31101 Allen Rd, Building 5, Southgate, MI 48195 | 2018-10-18 |
| 1255824025 | Kiesta Janell Lindsey | Social Worker | 13101 Allen Rd Bldg 4-f, Southgate, MI 48195 | 2018-06-07 |
| 1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
| 1275069486 | Liza Du Plessis | Student in an Organized Health Care Education/Training Program | 13111 Allen Road, Southgate, MI 48195 | 2017-05-08 |
| 1497290456 | Beaumont Health | Clinic/Center | 15777 Northline, Southgate, MI 48195 | 2016-12-30 |
| 1184172876 | Felicia Wilson | Licensed Practical Nurse | 15771 Wildemere, Southgate, MI 48195 | 2016-09-12 |
| 1225487978 | Stacey Petrick-strickland | Technician, Other | 12189 Agnes, Southgate, MI 48195 | 2016-06-03 |
| 1205298486 | Ashley Francis | Hearing Instrument Specialist | 18800 Eureka Rd., Southgate, MICHIGAN 48195 | 2016-03-25 |
| Find all providers in zip 48195 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417473224 | Suzette Michele Watson | Nurse Practitioner | 14319 Dix-toledo, Southgate, MI 48195 | 2017-08-15 |
| 1932247889 | Clarisse Michelle Carter | Nurse Practitioner | 13667 Eureka Rd, Southgate, MI 48195-1332 | 2007-02-02 |
| 1417495524 | Diane Pearl | Nurse Practitioner | 15777 Northline Rd, Southgate, MI 48195-2385 | 2017-02-09 |
| 1972951200 | Fredy Masongsong | Nurse Practitioner | 12100 Dix Toledo Rd, Southgate, MI 48195-3531 | 2016-05-26 |
| 1295116804 | Amy Parenteau | Nurse Practitioner | 12811 Northline Rd, Southgate, MI 48195-1109 | 2015-06-10 |
| 1083708200 | Michelle Lorraine Pardee | Nurse Practitioner | 19275 Northline Rd, Southgate, MI 48195-2220 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972339 | Zeinab Berjaoui | Nurse Practitioner | 11496 Newbern Dr, Warren, MI 48093-2613 | 2020-11-08 |
| 1134720899 | Whitney Ashton Mervau | Nurse Practitioner | 3836 Haven Hill Ln, Williamsburg, MI 49690-9536 | 2020-11-07 |
| 1063013837 | Amy Lynn Wadsworth | Nurse Practitioner | 9259 Chambord Dr, Ypsilanti, MI 48197-9281 | 2020-11-06 |
| 1821699844 | Michelle Daldine | Nurse Practitioner | 38481 Gail St, Clinton Township, MI 48036-1823 | 2020-11-05 |
| 1710588876 | Coty Cole | Nurse Practitioner | 2065 South Center Rd, Ste A, Burton, MI 48519 | 2020-11-05 |
| 1205437175 | Michelle Jo Whitesel | Nurse Practitioner | 5861 Shadow Pines Ct, Howell, MI 48843-7130 | 2020-11-05 |
| 1326649617 | Melinda Lee Hawley | Nurse Practitioner | 4019 Stark Dr, West Branch, MI 48661-9633 | 2020-11-04 |
| 1720689193 | Mohammed Louthfur Rahman | Nurse Practitioner | Hoover Internal Medicine Pllc, 2930 Holbrook St, Hamtramck, MI 48212 | 2020-11-03 |
| 1619578234 | Devon Kruger | Nurse Practitioner | 4612 W David Hwy, Saranac, MI 48881-9740 | 2020-11-02 |
| 1760083208 | Ramonna Van Alstine | Nurse Practitioner | 13932 Fox Ridge Ln, Allenton, MI 48002-4525 | 2020-11-02 |
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| 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.