Healthcare Provider Details

I. General information

NPI: 1205003423
Provider Name (Legal Business Name): MRS. CAROLYNE ANN FINLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25027 RUBIN RD
WARREN MI
48089-1203
US

IV. Provider business mailing address

25027 RUBIN RD
WARREN MI
48089-1203
US

V. Phone/Fax

Practice location:
  • Phone: 586-497-8738
  • Fax: 586-497-8738
Mailing address:
  • Phone: 586-497-8738
  • Fax: 586-497-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberF540108067022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: