MEDICARE: DENURAH MENANNDRUZZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1366186686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENURAH MENANNDRUZZ

Provider Business Mailing Address
First Line	:	18600 FLORENCE ST STE TD6
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6600
Country	:	US
Telephone Number	:	586-879-0111
Fax Number	:	586-879-0555

Provider Business Practice Location Address
First Line	:	18600 FLORENCE ST STE TD6
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6600
Country	:	US
Telephone Number	:	586-879-0111
Fax Number	:	586-879-0555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	04/22/2022

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