Provider Demographics
NPI:1528799806
Name:ROUPAS, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:ROUPAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 FALERIA STREET
Mailing Address - Street 2:
Mailing Address - City:BELLE RIVER
Mailing Address - State:ON
Mailing Address - Zip Code:N0R 1A0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:519-566-2900
Practice Address - Fax:313-576-8422
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704228972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner