Healthcare Provider Details

I. General information

NPI: 1679397137
Provider Name (Legal Business Name): LAKIA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

1354 MARYLAND ST APT 1/2
GROSSE POINTE PARK MI
48230-1006
US

V. Phone/Fax

Practice location:
  • Phone: 248-250-1965
  • Fax:
Mailing address:
  • Phone: 248-250-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: