Provider Demographics
NPI:1285024547
Name:LEKANE, BERTIN
Entity Type:Individual
Prefix:
First Name:BERTIN
Middle Name:
Last Name:LEKANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10971 OAK LN
Mailing Address - Street 2:APT 4211
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4360
Mailing Address - Country:US
Mailing Address - Phone:734-620-3543
Mailing Address - Fax:
Practice Address - Street 1:10971 OAK LN
Practice Address - Street 2:APT 4211
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-4360
Practice Address - Country:US
Practice Address - Phone:734-620-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110722164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse