Healthcare Provider Details

I. General information

NPI: 1265972228
Provider Name (Legal Business Name): LAJUNNA OBIAKOR LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18640 MACK AVE # 691
GROSSE POINTE FARMS MI
48236-7700
US

IV. Provider business mailing address

PO BOX 36691
GROSSE POINTE MI
48236-0691
US

V. Phone/Fax

Practice location:
  • Phone: 313-485-3626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703109366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: