Healthcare Provider Details

I. General information

NPI: 1508843426
Provider Name (Legal Business Name): LATINA ALEXANDER CNA HHA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 HEYDEN ST
DETROIT MI
48228-2949
US

IV. Provider business mailing address

8660 HEYDEN ST
DETROIT MI
48228-2949
US

V. Phone/Fax

Practice location:
  • Phone: 248-808-4753
  • Fax: 313-945-6238
Mailing address:
  • Phone: 248-808-4753
  • Fax: 313-945-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number236771560292
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: