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General NPI Number Information
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NPI Number | 1679347611
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Entity Type | Individual
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Provider Name | IRENE CHEBIWOT MAIYO
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Gender | Female
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2631 SANIBEL HOLW
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City | HOLT
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State | MI
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Zip | 48842-8755
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Country | US
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Telephone | 517-528-2852
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 ERWIN RD
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City | DURHAM
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State | NC
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Zip | 27705-4505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704324669
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5019482
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License Number State | NC
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