Basic Information
| Provider Information | |||||||||
| NPI: | 1396852265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUTE | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 RESEARCH PARK DRIVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486688650 | ||||||||
| FaxNumber: | 2486688651 | ||||||||
| Practice Location | |||||||||
| Address1: | 41100 FOX RUN | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483774804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486688650 | ||||||||
| FaxNumber: | 2486688651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704126904 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | 4704126904 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1396852265 | 05 | MI | MEDICAID | 8305187 | 01 | EVERCARE | OTHER | 5008663690 | 01 | BCBS OF MI | OTHER |