Provider Demographics
NPI:1326777822
Name:GLOVER, MACY M
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:M
Last Name:GLOVER
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 1:20448 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1041
Mailing Address - Country:US
Mailing Address - Phone:313-878-4130
Mailing Address - Fax:
Practice Address - Street 1:20448 SALEM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1041
Practice Address - Country:US
Practice Address - Phone:313-878-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide