Provider Demographics
NPI:1073993705
Name:CLAY, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22600 MIDDLEBELT RD
Mailing Address - Street 2:TRLR F15
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3669
Mailing Address - Country:US
Mailing Address - Phone:770-203-3389
Mailing Address - Fax:
Practice Address - Street 1:22600 MIDDLEBELT RD
Practice Address - Street 2:TRLR F15
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3669
Practice Address - Country:US
Practice Address - Phone:770-203-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703098917164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse