Healthcare Provider Details

I. General information

NPI: 1780519694
Provider Name (Legal Business Name): DAVONNA ROCHELLE MONROE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 OTOOLE LN
MOUNT MORRIS MI
48458-2617
US

IV. Provider business mailing address

6211 OTOOLE LN
MOUNT MORRIS MI
48458-2617
US

V. Phone/Fax

Practice location:
  • Phone: 810-429-7191
  • Fax:
Mailing address:
  • Phone: 810-429-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberMI09122024941496
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: