Provider Demographics
NPI:1548495054
Name:DERECZYK, DARLENE CARYN (ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:CARYN
Last Name:DERECZYK
Suffix:
Gender:F
Credentials:ACNP-BC
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Mailing Address - Street 1:6415 CONNAUGHT CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5484
Mailing Address - Country:US
Mailing Address - Phone:313-283-7740
Mailing Address - Fax:313-916-8007
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-283-7740
Practice Address - Fax:313-916-8007
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2010-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI470410969363LA2100X
MI4704140969163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine