Robert Secor, FNP

Individual provider Active NPI Family Nurse Practitioner · Delton, MI

NPI 1700327640 · NPPES record last updated Mar 11, 2017

Key facts

NPI
1700327640
Entity type
Individual (NPI type 1)
Primary specialty
Family Nurse Practitioner 363LF0000X
License
4704226211 (MI)
Practice address
4301 Harrington Rd
Delton, MI 49046-9568
Phone
(269) 580-1093
NPI assigned
Mar 11, 2017
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704226211MIMDFamily Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704226211 MI Yes

Addresses

Primary practice location

4301 Harrington Rd
Delton, MI 49046-9568

Mailing address

11320 S M 43 Hwy
Delton, MI 49046-9415
Phone (269) 623-5521

Other providers in Delton, MI

All providers in Delton, MI · Family Nurse Practitioner in Michigan

Sources for this page

Verify at the official NPI Registry.