Healthcare Provider Details

I. General information

NPI: 1962727032
Provider Name (Legal Business Name): MAXINE KAY DOWNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 LYONS RD
LYONS MI
48851-9708
US

IV. Provider business mailing address

2556 LYONS RD
LYONS MI
48851-9708
US

V. Phone/Fax

Practice location:
  • Phone: 989-855-2219
  • Fax: 248-588-2828
Mailing address:
  • Phone: 989-855-2219
  • Fax: 248-588-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704113445
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN551037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: