Provider Demographics
NPI:1477219285
Name:CLAY, MAXINE RUTH (LPN)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:RUTH
Last Name:CLAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 N INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1668
Mailing Address - Country:US
Mailing Address - Phone:734-274-7879
Mailing Address - Fax:734-274-7933
Practice Address - Street 1:7430 N INKSTER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1668
Practice Address - Country:US
Practice Address - Phone:734-274-7879
Practice Address - Fax:734-274-7933
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703113900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse