Healthcare Provider Details

I. General information

NPI: 1922596238
Provider Name (Legal Business Name): MALVINIA MARTINE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20919 BEHRENDT AVE
WARREN MI
48091-2771
US

IV. Provider business mailing address

20919 BEHRENDT AVE
WARREN MI
48091-2771
US

V. Phone/Fax

Practice location:
  • Phone: 313-721-3313
  • Fax:
Mailing address:
  • Phone: 313-721-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: