Healthcare Provider Details

I. General information

NPI: 1831496371
Provider Name (Legal Business Name): MS. ALISA MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 ORLEANS ST
DETROIT MI
48207-2906
US

IV. Provider business mailing address

1907 ORLEANS ST
DETROIT MI
48207-2906
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-7974
  • Fax:
Mailing address:
  • Phone: 313-656-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number230014960310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: