Healthcare Provider Details

I. General information

NPI: 1306677315
Provider Name (Legal Business Name): MRS. KENYETTA STRAWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17331 E WARREN AVE
DETROIT MI
48224-2215
US

IV. Provider business mailing address

PO BOX 35063
DETROIT MI
48235-0063
US

V. Phone/Fax

Practice location:
  • Phone: 313-753-8495
  • Fax:
Mailing address:
  • Phone: 313-758-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: