Provider Demographics
NPI:1538772397
Name:KAJDAN, NICHOLAS J (FNP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:KAJDAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36765 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2769
Mailing Address - Country:US
Mailing Address - Phone:586-280-2345
Mailing Address - Fax:586-280-2347
Practice Address - Street 1:36765 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2769
Practice Address - Country:US
Practice Address - Phone:586-280-2345
Practice Address - Fax:586-280-2347
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176174163W00000X
WI10627-33363L00000X
MI4704374041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner