Provider Demographics
NPI:1578940086
Name:BOVEN, MANDI ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:MANDI
Middle Name:ELIZABETH
Last Name:BOVEN
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 1:14741 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5104
Mailing Address - Country:US
Mailing Address - Phone:734-363-3957
Mailing Address - Fax:734-464-6205
Practice Address - Street 1:14741 FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5104
Practice Address - Country:US
Practice Address - Phone:734-363-3957
Practice Address - Fax:734-464-6205
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide