Healthcare Provider Details

I. General information

NPI: 1629902168
Provider Name (Legal Business Name): KORENA METCALFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 SOFTWATER LAKE DR
LINDEN MI
48451-8501
US

IV. Provider business mailing address

15571 PINE CONE CT
LINDEN MI
48451-8758
US

V. Phone/Fax

Practice location:
  • Phone: 810-459-0491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: