Healthcare Provider Details

I. General information

NPI: 1053158162
Provider Name (Legal Business Name): MESHA HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41000 WOODWARD AVE STE 350
BLOOMFIELD HILLS MI
48304-5092
US

IV. Provider business mailing address

PO BOX 430402
PONTIAC MI
48343-0402
US

V. Phone/Fax

Practice location:
  • Phone: 248-978-6070
  • Fax:
Mailing address:
  • Phone: 248-978-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230014613490609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: