Provider Demographics
NPI:1508843426
Name:ALEXANDER, LATINA (CNA HHA MA)
Entity Type:Individual
Prefix:MS
First Name:LATINA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CNA HHA MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 HEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2949
Mailing Address - Country:US
Mailing Address - Phone:248-808-4753
Mailing Address - Fax:313-945-6238
Practice Address - Street 1:8660 HEYDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2949
Practice Address - Country:US
Practice Address - Phone:248-808-4753
Practice Address - Fax:313-945-6238
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI236771560292376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide