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General NPI Number Information
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NPI Number | 1023673639
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Entity Type | Organization
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Legal Business Name | ANNOINTED OUTREACH
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 1175 BALDWIN AVE
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City | PONTIAC
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State | MI
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Zip | 48340-2709
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Country | US
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Telephone | 248-221-5469
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 BALDWIN AVE
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City | PONTIAC
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State | MI
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Zip | 48340-2709
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Country | US
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Telephone | 248-221-5469
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAZON JOHNSON
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Credential |
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Telephone | 248-221-5469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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