Healthcare Provider Details

I. General information

NPI: 1982192027
Provider Name (Legal Business Name): PORCHIA DURANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7436 WOODWARD AVE
DETROIT MI
48202-3100
US

IV. Provider business mailing address

5685 WESTPOINT ST
DEARBORN HEIGHTS MI
48125-2351
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-4663
  • Fax: 313-633-0585
Mailing address:
  • Phone: 248-910-4663
  • Fax: 313-633-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: