Provider Demographics
NPI:1700328135
Name:SIMPSON, DEANGELLA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DEANGELLA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21650 W 11 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3777
Mailing Address - Country:US
Mailing Address - Phone:248-327-6196
Mailing Address - Fax:
Practice Address - Street 1:21650 W 11 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3777
Practice Address - Country:US
Practice Address - Phone:248-327-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704183214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily