Provider Demographics
NPI:1093489528
Name:MCNABB, JOYCE
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:MCNABB
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 1:6635 W. MARLETTE STREET
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453
Mailing Address - Country:US
Mailing Address - Phone:989-635-7176
Mailing Address - Fax:
Practice Address - Street 1:6635 W. MARLETTE STREET
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453
Practice Address - Country:US
Practice Address - Phone:989-635-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF760367059311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home