Healthcare Provider Details

I. General information

NPI: 1376925156
Provider Name (Legal Business Name): ANEISHA THURMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5279 CADIEUX RD
DETROIT MI
48224-2111
US

IV. Provider business mailing address

5279 CADIEUX RD
DETROIT MI
48224-2111
US

V. Phone/Fax

Practice location:
  • Phone: 248-595-3035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: