Provider Demographics
NPI:1174125199
Name:JUNCAJ, AIMEE ROSE (DNP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:ROSE
Last Name:JUNCAJ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:ROSE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2024 NIAGARA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5665
Mailing Address - Country:US
Mailing Address - Phone:248-302-0356
Mailing Address - Fax:
Practice Address - Street 1:2024 NIAGARA DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5665
Practice Address - Country:US
Practice Address - Phone:248-302-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1111111363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care