Healthcare Provider Details

I. General information

NPI: 1346182003
Provider Name (Legal Business Name): DAWANDA COLE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23074 OLYMPIA DR
CLINTON TWP MI
48036-4600
US

IV. Provider business mailing address

23074 OLYMPIA DR
CLINTON TWP MI
48036-4600
US

V. Phone/Fax

Practice location:
  • Phone: 470-779-4054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703131634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: