Provider Demographics
NPI:1225561830
Name:FORD, MACY ANNE-NOEL
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:ANNE-NOEL
Last Name:FORD
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 1:18609 E 9TH CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8652
Mailing Address - Country:US
Mailing Address - Phone:208-651-9495
Mailing Address - Fax:
Practice Address - Street 1:18609 E 9TH CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-8652
Practice Address - Country:US
Practice Address - Phone:208-651-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000000019202376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000000019202OtherNURSE ASSISTANT CERTIFICATION