Healthcare Provider Details

I. General information

NPI: 1679347611
Provider Name (Legal Business Name): IRENE CHEBIWOT MAIYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 SANIBEL HOLW
HOLT MI
48842-8755
US

IV. Provider business mailing address

3100 ERWIN RD
DURHAM NC
27705-4505
US

V. Phone/Fax

Practice location:
  • Phone: 517-528-2852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704324669
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019482
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: