Basic Information
| Provider Information | |||||||||
| NPI: | 1457970444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDMOND | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | KAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2255 S LINDEN RD STE A | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485325417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107328087 | ||||||||
| FaxNumber: | 8775395855 | ||||||||
| Practice Location | |||||||||
| Address1: | 2255 S LINDEN RD STE A | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485325417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107328087 | ||||||||
| FaxNumber: | 8775395855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2020 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704155229 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.