Keanna Jaleesa Dildy
Technician/Technologist
19251 Mack Ave Ste M450
Grosse Pointe Woods
, Michigan 48236-2893
Keanna Jaleesa Dildy
Technician/Technologist
19251 Mack Ave Ste M450
Grosse Pointe Woods
, Michigan 48236-2893
(248) 712-4381
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About
Features
Specialties
- Technician/Technologist
Languages spoken
- English
Location
First Address
- Keanna Jaleesa Dildy
- 19251 Mack Ave Ste M450
- Grosse Pointe Woods, MI
- Zip : 48236-2893
- Fax : (248) 712-4381
- Phone : (313) 343-1370
Second Address
- Keanna Jaleesa Dildy
- 19251 Mack Ave Ste M450
- Grosse Pointe Woods, MI
- Zip : 48236-2893
- Fax : (248) 712-4381
- Phone : (313) 343-1370
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 156F00000X | Technician/Technologist |
National Provider Identifier
| NPI | 1265016869 |
|---|---|
| Provider Name | Keanna Jaleesa Dildy |
| First Address | Grosse Pointe Woods, MI 48236-2893 |
| Second Address | Grosse Pointe Woods, MI 48236-2893 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/05/2021 |
| Last Update Date | 10/05/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.