Healthcare Provider Details

I. General information

NPI: 1952914533
Provider Name (Legal Business Name): KIANA PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19750 BURT RD
DETROIT MI
48219-2078
US

IV. Provider business mailing address

36963 S HEATHER CT
WESTLAND MI
48185-5401
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704364249TMP20
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: