Provider Demographics
NPI:1518290840
Name:JOYELLA, KAYLA C (NURSE)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:C
Last Name:JOYELLA
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 FORT PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1754
Mailing Address - Country:US
Mailing Address - Phone:586-222-6827
Mailing Address - Fax:
Practice Address - Street 1:1555 FORT PARK BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1754
Practice Address - Country:US
Practice Address - Phone:586-222-6827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703087186164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse