Provider Demographics
NPI:1477253029
Name:FRIDAY, KAITLYN VICTORIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:VICTORIA
Last Name:FRIDAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:VICTORIA
Other - Last Name:FRIDAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED PRACTICAL N
Mailing Address - Street 1:6817 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-5407
Mailing Address - Country:US
Mailing Address - Phone:248-632-4435
Mailing Address - Fax:
Practice Address - Street 1:6817 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-5407
Practice Address - Country:US
Practice Address - Phone:248-632-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703127726251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care