MEDICARE: NATASHA GENNINGS

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	164X00000X	Licensed Vocational Nurse	4703113653	MI

General Provider Information

NPI Number	:	1932508231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA GENNINGS

Provider Business Mailing Address
First Line	:	20491 NORWOOD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1825
Country	:	US
Telephone Number	:	313-622-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	20491 NORWOOD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1825
Country	:	US
Telephone Number	:	313-622-1097
Fax Number	:

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

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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Directions to “ NATASHA GENNINGS ” Practice Location

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