MEDICARE: MS. LATINA ALEXANDER CNA HHA MA

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	376K00000X	Nurse's Aide	236771560292	MI

General Provider Information

NPI Number	:	1508843426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATINA ALEXANDER CNA HHA MA

Provider Business Mailing Address
First Line	:	8660 HEYDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2949
Country	:	US
Telephone Number	:	248-808-4753
Fax Number	:	313-945-6238

Provider Business Practice Location Address
First Line	:	8660 HEYDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2949
Country	:	US
Telephone Number	:	248-808-4753
Fax Number	:	313-945-6238

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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