Healthcare Provider Details

I. General information

NPI: 1760745731
Provider Name (Legal Business Name): NANA POMAA DAINING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 LEONARD ST NE
GRAND RAPIDS MI
49503-1129
US

IV. Provider business mailing address

385 LEONARD ST NE
GRAND RAPIDS MI
49503-1129
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-6719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: