Healthcare Provider Details

I. General information

NPI: 1518086677
Provider Name (Legal Business Name): ABIGAIL OMABELE CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13220 WOODWARD AVE
DETROIT MI
48203-3610
US

IV. Provider business mailing address

162O1 CRUSE ST.
DETROIT MI
48235
US

V. Phone/Fax

Practice location:
  • Phone: 313-868-1946
  • Fax: 313-852-1631
Mailing address:
  • Phone: 313-838-0078
  • Fax: 313-852-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230004991771199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: