Provider Demographics
NPI:1437854387
Name:HOWARD, PHONCELLA
Entity Type:Individual
Prefix:MRS
First Name:PHONCELLA
Middle Name:
Last Name:HOWARD
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 1:4201 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1607
Mailing Address - Country:US
Mailing Address - Phone:313-643-7771
Mailing Address - Fax:
Practice Address - Street 1:4201 CHERRY HILL DR
Practice Address - Street 2:
Practice Address - City:ORCHARD LAKE
Practice Address - State:MI
Practice Address - Zip Code:48323-1607
Practice Address - Country:US
Practice Address - Phone:313-643-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula