Healthcare Provider Details

I. General information

NPI: 1487209581
Provider Name (Legal Business Name): MONKEIDA PHALET RELERFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONKEIDA PHALET LUCKETT

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N M 52 STE 1
OWOSSO MI
48867-1025
US

IV. Provider business mailing address

2189 MAPLEVIEW CT
DAVISON MI
48423-7811
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8239
  • Fax: 989-723-8230
Mailing address:
  • Phone: 810-853-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801109259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: