Healthcare Provider Details

I. General information

NPI: 1669922613
Provider Name (Legal Business Name): REYONNA HOLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 HOOVER ST
WAYNE MI
48184-2623
US

IV. Provider business mailing address

5625 HOOVER ST
WAYNE MI
48184-2623
US

V. Phone/Fax

Practice location:
  • Phone: 313-442-2924
  • Fax:
Mailing address:
  • Phone: 313-442-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703120295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: