Provider Demographics
NPI:1356953756
Name:MAILEY, JOHN WESTLEY JR (NP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESTLEY
Last Name:MAILEY
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27645 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1012
Mailing Address - Country:US
Mailing Address - Phone:313-332-0872
Mailing Address - Fax:313-332-0946
Practice Address - Street 1:27645 ALBERT ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1012
Practice Address - Country:US
Practice Address - Phone:313-310-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199755363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704199755OtherNURSING ADVANCED PRACTICE LICENSE