Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | MI |
NPI | 1447877212 |
---|---|
Provider Name | Kewanna Lenise Hill |
First Address | Livonia, MI 48152-1358 |
Second Address | Redford, MI 48240-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2020 |
Last Update Date | 20/08/2021 |