Provider Demographics
NPI:1164209797
Name:PLESCO, MIKISHA
Entity Type:Individual
Prefix:
First Name:MIKISHA
Middle Name:
Last Name:PLESCO
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:PO BOX 88061
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49518-0061
Mailing Address - Country:US
Mailing Address - Phone:616-344-8997
Mailing Address - Fax:
Practice Address - Street 1:4352 KIMBALL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3581
Practice Address - Country:US
Practice Address - Phone:616-344-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN